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Health Equity in Times of Crisis: The impact of economic and public health shocks on access to care among women in Zimbabwe and the United States
Full text linkAbstract
This dissertation examines health equity during times of national public health and economic crises by examining access to care among women of reproductive age. Papers 1 and 2 estimate the effects of the 2020 Covid-19 pandemic in the United States (US). Paper 3 examines the potential effects of the 2008 hyperinflation and subsequent economic crisis in Zimbabwe.
Paper 1 assessed the role of health professional shortage areas (HPSAs) in the Covid-19 pandemic-related temporal trends in mental health access among women in the 18 to 44 years age group with self-reported anxiety and/or depression. The findings suggest decreased unmet prescription needs in the full sample and in HPSAs. The results also suggest an increase in unmet mental health needs due to cost in non-HPSAs in the second year of the pandemic, relative to the pre-pandemic year. This evidence supports maintaining some Public Health Emergency (PHE) actions and policies that could have contributed to a reduction in unmet prescription needs and, alternatively, suggests the need for licensing more prescribing mental health providers.
Paper 2 examined the role of telehealth utilization in the association between race/ethnicity and access to care among women in the 18 to 49 years age group with self-reported hypertension and/or diabetes. The results suggest that Non-Hispanic (NH) Black women were more likely to go to the ER/ED (in the full sample and among telehealth users) relative to NH White women. These findings suggest digital health equity concerns because of the disparities in the need for acute healthcare services among NH Black women (even when they use telehealth services). This work adds to the growing evidence promoting health equity in hybrid integration of telehealth to promote care coordination and telehealth payment parity to ensure that everyone can access the same quality of care.
Paper 3 (Chapter 4) estimated rural-urban disparities in the impact of Zimbabwe’s 2008 hyperinflation and economic crisis on access to care among women and adolescents in the 15 to 49 years age group. The difference-in-differences results suggest that experiencing hyperinflation and the subsequent economic crisis in Zimbabwe was associated with increased unmet medical needs due to cost in the full sample, and among urban residents. This work presents evidence that potentially highlights the impact of urban poverty on access to care in Zimbabwe.
The evidence presented in this dissertation confirms what we know from prior literature – times of national crisis and uncertainty expose or exacerbate disparities in access to care. This knowledge can inform health policies that prioritize health equity when preparing for and reacting to national crises
Development of Novel Signatures for Determination of Cell Types in Blood and Saliva Mixtures
No full textDetermination of tissue source and the time at which a biological material is transferred from its source to another surface, known as the time-since-deposition (TSD), would assist forensic analysts by providing crucial context for DNA profiles generated from biological evidence. Many methods for cell identification have been explored using biomolecule markers such as mRNA, miRNA, and differential DNA methylation. Forensic laboratories have also developed methods for TSD estimation that focus on degradation of biomolecules. Biomolecules such as mRNA or miRNA degrade at different rates due to some being more stable than others. The ratio of stable degrading biomolecules, therefore, can be related to TSD. However, these methods have not been validated for use in a forensic science laboratory due to high false positive rates, limited application to different biological fluids, and the destructive nature of many existing methods. Flow cytometry is an analytical technique that is used to measure autofluorescence and structural properties to characterize cells in a non-destructive and high-throughput manner. Past studies have utilized flow cytometry to identify tissue source and determine TSD; however, these signatures were always tested in separate experimental efforts on different sets of samples which may not be feasible to implement in the operational workflow of a forensic laboratory.
The goal of the research project reported herein was to develop a single laboratory technique for determining TSD and source tissue for an unknown biological sample. Previous experiments focused on blood samples that ranged in concentration from neat to 1:1,000 dilution and varied in the TSDs between 1 day and six months. To test whether this technique could also be used in mixed tissue samples, blood/saliva mixtures from ten donors were deposited in duplicates onto microscope slides and air dried at ambient conditions. The mixture ratios were prepared as follows: 1:1, 1:5, 1:10, 1:50, and 1:100, with blood as the minor and saliva as the major contributor and collected in intervals between T = 0 days and T = 90 days. Samples were eluted analyzed using a flow cytometer equipped with 488nm excitation laser. After each sample was processed on the flow cytometer, the flow through was collected to undergo DNA analysis.
Results showed that both blood and saliva cells had distinct fluorescence profiles. Blood cells consistently fluoresced at a magnitude of 103 and higher in red and yellow fluorescence channels. Saliva cell consistently fluoresced at a magnitude of 103 and lower in red and yellow fluorescence channels. The observed trends in blood and saliva mixtures, not consistent with trends previously recognized in these fluids independently, did not show a clear TSD signature. Actual cell counts and ratios did not match the theoretical cell counts and ratios that are expected from the body fluids used in this study
Biodistribution and Method Validation of Xylazine in a Mouse Model Using Liquid-Chromatography-Quadrupole-Time of Flight Mass Spectrometry
No full textXylazine is a nonopioid veterinary sedative and an α2 adrenergic receptor agonist. It emerged in the opioid epidemic as an adulterant of illicit fentanyl. As xylazine becomes more involved in fatal overdoses, it is relevant to elucidate its biodistribution post-exposure due to its exacerbation of adverse events, namely respiratory depression, as xylazine’s contributions to existing adverse effects of synthetic opioids is understudied. A bioanalytical method to quantify xylazine and select metabolites in tissue using LC-QToF was validated and applied to a preclinical mouse model in order to characterize xylazine’s biodistribution in whole blood and six tissues at a dose known to induce respiratory depression in mice. Mice were dosed intraperitoneally (i.p.) at five distinct sampling times (5, 30, 60, 240, 360 minutes) prior to sacrifice in order to evaluate the time course of xylazine distribution. Xylazine is primarily distributed to the liver, kidneys, and stomach. The time course of drug distribution differed between xylazine and its metabolite xylazine glucuronide, with xylazine reaching the maximum concentration in each tissue much sooner on average compared to xylazine glucuronide. These findings suggest that metabolism begins soon after i.p. administration and that the effects of xylazine may be organ-specific
Junior Recital, Maia Timm, violin
Full text linkJunior recitalMaia Timm, violinSasha Wang, pianoMonday, April 28, 2025 at 7:30 p.m.Recital HallJames W. Black Music Center1015 Grove Avenue | Richmond, VirginiaThe presentation of this junior recital will fulfill in part the requirements for the Bachelor of Music degree in Music Education. Maia Timm studies violin with Prof. Susanna Klein
Trumpet Studio Recital
Full text linkTrumpet Studio Recitalstudents from the studio of Professor Sam HusswithDaniel Stipe, pianoSunday, April 6, 2025 at 7:00 p.m.Sonia Vlahcevic Concert HallW.E. Singleton Center for the Performing Arts922 Park Avenue | Richmond, Virgini
String Area Recital
Full text linkString Area RecitalMonday, April 28, 2025 at 2:00 p.m.Recital HallJames W. Black Music Center1015 Grove Avenue | Richmond, Virgini
Artist in Residence Recital, disc two
Full text linkDisc two of twoNeave TriopresentsRemembrancesSaturday, March 22, 2025 at 7:00 p.m.Sonia Vlahcevic Concert HallW.E. Singleton Center for the Performing Arts922 Park Avenue | Richmond, Virgini
Getting Heard
Full text linkGetting Heard summarize Herold\u27s experience with legislative advocacy in her career as a librarian
Dynamic Expression of Transposable Elements Contributes to Molecular and Behavioral Adaptations to Cocaine
No full textThe comorbidity of substance use disorder (SUDs) — specifically cocaine use disorder (CUD)— with anxiety and social deficit disorders complicates effective long-term treatment. More research is needed to understand the brain-region and cell type-specific mechanisms underlying these disorders to better address treatment gaps. This dissertation investigates the role of the transcription factor of interest ZFP189, a Krüppel-associated box (KRAB) zinc finger protein (ZFP), in governing pro-social behavior and the development of CUD across interconnected brain regions. We show that ZFP189 directly regulates transposable elements (TEs), repetitive DNA sequences capable of mobilizing and reinserting into the genome, which leads to subsequent molecular and behavioral responses. Using synthetic biology, we show that ZFP189 maintains pro-social behavior in the prefrontal cortex (PFC) by regulating TEs. Reversing ZFP189 function with ZFP189VPR down-regulated immune responses and impaired pro-social behavior. Utilizing the same synthetic biological approaches, the same opposing synthetic ZFP189 transcription factor variants were shown to function similarly in the opposing medium spiny neurons (MSNs) of the nucleus accumbens (NAc) to facilitate (ZFP189WT) or blunt (ZFP189VPR) cocaine responses again by differentially modulating immune responses. Collectively, this work points to a previously understudied area of research linking KZFPs, TEs, and immune responses to the maintenance of pro-social behaviors and the development of CUD within intertwined brain regions. Future research should investigate the link between social behavior and CUD progression through ZFP189-TE interactions in the diverse cell types of the brain to develop targeted intervention strategies without altering parallel but similarly involved pathways
WIAN
Full text link“Am I named after someone? A relative? A friend of my father? A friend of yours? Or did you just pick it out of a hat?”
Names, like everything else, are made of stories. A boy, on the cusp of adulthood, asks his mother what his is