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A Survey of Family Medicine Residency Programs in Washington: Evaluating the Current State of Correctional Health Training and Future Recommendations
No full textThesis (Master's)--University of Washington, 2023Background: There are more than 2.2 million people in the US under correctional control, exceeding corresponding population growth and crime rates. (Nowotny, 2021). Correctional control is a term used to refer to individuals who are under some form of correctional supervision, including those who are incarcerated in jails or prisons, as well as those who are on probation or parole. These individuals are subject to various forms of monitoring and restrictions, which can have a significant impact on health and well-being (Massoglia & Remster, 2019a). People experiencing incarceration are often highly historically marginalized. African American and Latino, as well as low income individuals and communities are disproportionately affected (Whitehorn, 2021).
Incarceration exacerbates disparities in health care access, quality of care, and overall quality of life (Minkler, 2020). The delivery of healthcare within the criminal-legal system is often unpredictable, leading to episodic, poorly coordinated acute, chronic, and preventative care. Unfortunately, undergraduate and graduate medical education training programs often do not recognize the importance of learning to care for currently or formerly incarcerated people. Due to the unique healthcare needs of these underserved populations, it is important for physicians to have training in correctional health care.
Methods: A cross-sectional survey was developed and sent to the program directors for all 21 Family Medicine residency programs in Washington State. In addition to demographic questions such as program structure and number of residents in the program, key survey topics included questions about dedicated training in correctional health, barriers in establishing correctional health curriculum, and interest in implementing or expanding these curricula. Descriptive statistics were summarized in each area in regard to demographics, content, attitudes, and open ended responses.
Results: A response rate of 80% was achieved, with n=17 responses. The majority of respondents were from either a community-based and university-affiliated program. The majority of programs do not currently care for incarcerated people receiving medical care outside of the jail/prison/juvenile detention setting (n=10, 59%). Of those who do currently care for incarcerated people, the majority of the time was in an inpatient rotation or outpatient setting. Also from those who currently care for incarcerated people, all included some didactic learning component (n=6, 100%). Common barriers to expanding correctional medicine in curriculum were time constraints and difficulty scheduling, faculty bandwidth, paperwork, and lack of partnership with correctional facilities.
Conclusion: This study highlights the need to address correctional health in family medicine residency training programs, as the majority do not currently provide dedicated correctional medicine training. The findings emphasize the need for increased educational awareness and cross-sector partnerships to better prepare future family medicine physicians for the unique health challenges faced by incarcerated individuals. Furthermore, by recognizing that incarcerated individuals are integral to community health, improvements can be made for individuals transitioning out of incarceration and reducing health disparities among this disadvantaged population. Overcoming these barriers will ensure comprehensive medical training, ultimately fostering health equity
Pierce County, Washington: The 1918 Influenza Pandemic and Public Health
No full textBachelor of Arts (BA)As of 105 years ago this October, the deadliest pandemic of the twentieth century arrived in Tacoma and the greater Pierce County area, putting its residents and officials in an arduous position. The choices made in October of 1918 were not made lightly, as the potential for a public health crisis weighed heavily on the minds of those in the face of the "Spanish Flu." With a public health lens, I have used local newspapers, health reports, military history books, the transcripts of the Pierce County Medical Society meetings, and adjacent scholarship to analyze the influenza policies of 1918 Peirce County. My research began with a desire to know the response of my home county during this medical crisis. Furthermore, I wanted to know the reactions of the county's officials and professionals and what measures they deemed necessary or superfluous. The public health measures that Pierce County implemented were impressive, given that the field of public health was a more novel aspect of the United States government. However, the pandemic's slowing infection rates in November and December of 1918, media reactions to the pandemic, and lack of medical unity made long-standing policies tough to maintain. For these very reasons, within this essay, I argue that the effectiveness of the county's public health measures was undermined, resulting in the premature lifting and ceasing of cohesive public health policies. A review of these various policies, their strengths, and their failures not only gives a deep look at a local history that has often remained ignored or overlooked but helps prepare for future pandemics and further retain lessons from our most recent one
A Philological, Text Critical Reading of Sections of Chapter Five of the Yellow Emperor's Inner Classic, Basic Questions
No full textThesis (Master's)--University of Washington, 2023The Yellow Emperor’s Inner Classic is the Han dynasty (206 BCE – 220 CE) medical text at the center of professional, literature-based medical practice in China for the last two-thousand years. Since the Song dynasty, roughly one thousand years ago, a single government sanctioned version of the first of the two books of the Inner Classic, “Basic Questions”, has acted as the authoritative version until modern times, the vast majority of scholars referencing it exclusively. This authoritative Song version took as its master copy an eighth century version which had undergone extensive changes. A seventh century text, the Grand Basis, contains most of “Basic Questions” and that in a state that did not get altered during the eighth century. This suggests Grand Basis is a closer reflection of the original Han “Basic Questions” than that which has acted as the authoritative version for the last thousand years. This research makes a close, critical comparison of portions of chapter five of “Basic Questions”. The goal was to determine the existence and nature of differences between the Song version and Grand Basis. Though too small a sample to arrive at definitive conclusions several differences were revealed suggesting, tentatively, an attempt on the original Han authors’ part to make their intent clear, this lost or concealed in the Song version. Enough differences of a meaningful type were found to warrant further, more complete investigation
Characterization and Modeling of Spatiotemporal Behaviors in Corals, Elastic Metamaterials and Origami
No full textThesis (Ph.D.)--University of Washington, 2023Spatiotemporal behaviors have been widely found in natural and artificial systems, indicating the movement and dynamics that occur in both space and time. These behaviors have significant impact on numerous fields, including ecology, finance, transportation and mechanical engineering. Some examples of spatiotemporal behaviors in these fields include the movement of animals, human behaviors, traffic flow, and vibrations. Understanding spatiotemporal behaviors is essential for developing effective management strategies and gaining insights into the underlying physical mechanisms that motivate these behaviors. Coral reef ecosystems harbor a vast range of species and biological activities, but they are facing a severe crisis caused by the increasingly intensive anthropogenic activities and climate change. To better understand the impact of these challenges on coral reef survival and fitness, it is essential to comprehend the behaviors of corals in a timely manner. Coral motion, encompassing the movements of tissues, polyps, and tentacles, is a fundamental behavioral trait of the coral holobiont that plays a critical role in feeding, competition, reproduction, and ultimately survival. As a result, characterizing coral behaviors through motion analysis can aid our understanding in basic biological and physical functions. Nevertheless, characterization and modeling of coral motion are challenging and largely unexplored, given the complexity of the biological system and the inherent spatiotemporal multi-scale features of these movements. Apart from the corals, artificial systems such as elastic metamaterials and origami structures also possess spatiotemporal behaviors such as elastic wave propagation and structural dynamics. However, the lack of corresponding data-driven analysis and nonlinear nature of origami structures result in the research voids. To address these challenges in characterization and modeling of spatiotemporal behaviors, in terms of coral motions, we have implemented a range of approaches, including observation techniques, imaging processing techniques, and theoretical/data-driven modeling. Specifically, we have employed several techniques used in the engineering fields such as digital image correlation, motion magnification and object tracking, as well as modeling methods such as the Langevin equation and dynamic mode decomposition. These methods have been proven effective in characterizing and modeling the motion of coral tissues, polyps and tentacles. By combining these different approaches, we aim to better understand the underlying biophysics of corals and to develop new tools and methodologies for managing the impact of climate change on coral reef ecosystems. Furthermore, in terms of elastic metamaterials and origami, we use theoretical modeling and dynamic mode decomposition(and its variants) to characterize and model the corresponding systems. Our approaches provide insights into the underlying physics in wave dynamics and structural dynamics, and develop models for predicting the future responses under external stimuli. Our work has not only resulted in unparalleled understanding of coral biophysical behaviors in terms of motions, providing a useful toolkit for the coral research community to face the challenges in the future climate change, but also paved the way in characterizing and modeling elastic wave propagation and origami dynamics using theoretical/data-driven methods. We anticipate that our methods, particularly the data-driven approach of dynamic mode decomposition, will be applicable to solve problems of dynamics in a variety of complex systems in the future research
Planetesimal Accretion in the Solar System and Beyond: An Application to Systems of Tightly-Packed Inner Planets
No full textThesis (Ph.D.)--University of Washington, 2023Planetesimals are the smallest gravitationally bound objects to play a role in the planet formation process. In a bottom-up fashion, these bodies are thought to collide and grow to form protoplanets, which are roughly Mars-sized objects, and then eventually coalesce into larger worlds. Throughout this process, some planetesimals are left behind and can persist for billions of years after the formation of a planetary system. This is believed to be the principal source of asteroid and Kuiper belt objects, among many other small body populations in the present-day solar system. In addition to providing clues about the process of planet formation, planetesimals can also transport planets themselves, through weak but numerous gravitational interactions. Planetesimals around other stars sometimes collide and generate dust, producing a distinct observational marker that can be used to infer their presence. In this thesis, I use state of the art N-body simulations to understand the dynamics that govern planetesimal interactions and growth. For the first time, I follow this growth process using bodies with masses comparable to those predicted by planetesimal formation models. Upon doing so, I show that certain dynamical mechanisms involving mean-motion resonances only operate with sufficiently high resolution, and the effects of these mechanisms place a number of constraints on the planet formation process, including tracing the initial sizes of planetesimal formation and using collisionally-generated dust to infer the orbital properties of unseen planets in nearby disks. I also use these resolution capabilities to directly follow the growth of a system of terrestrial planets, starting from planetesimals. In doing so, I assess the viability of an in-situ formation model for systems of tightly-packed inner planets (STIPs), which appear to be a common outcome of planet formation. I also use these simulation results to train a neural network to generate a larger set of post-planetesimal accretion phase initial conditions, which I leverage to construct a statistical sample of simulated planetary systems for comparison with observations
Towards a multi-scale, socio-technical view of the design and evaluation of water, sanitation, and hygiene infrastructure
No full textThesis (Ph.D.)--University of Washington, 2023Water, sanitation, and hygiene (WASH) are important prerequisites to human health, yet global investments in this infrastructure do not always deliver the expected benefits. The relationships between WASH and health are complex, and not fully accounting for these complexities in the design and evaluation of interventions may be limiting implementation success. In this dissertation I help the WASH sector reimagine how infrastructure can be engineered and its contributions to health and level of service measured. I propose greater implementation of a multi-scale, socio-technical perspective of infrastructure in the design and evaluation process. I present a diverse collection of research projects, each with a different scope, scale, and/or evaluation technique linked to evidence-based design suggestions. I conclude by reflecting on key conventions underlying WASH infrastructure development – namely, the use of the term community and the application of global technical WASH standards – to further demonstrate the value of a multi-scale, socio-technical approach.
Chapter 3 of this dissertation has been accepted for publication but is not the Version of Record. It includes some but not all of the modifications requested in the peer review process and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: http://dx.doi.org/10.1038/s44221-023-00112-6. Use of this Accepted Version is subject to the publisher’s Accepted Manuscript terms of use https://www.springernature.com/gp/open-research/policies/accepted- manuscript-term
Development of Long-acting Formulation of Dolutegravir Sodium for Human Immunodeficiency Virus
No full textThesis (Master's)--University of Washington, 2023Human immunodeficiency virus (HIV) is an enveloped retrovirus that attacks the infected human host’s immune system by destroying CD4 lymphocytes, the cells responsible for
providing protection against infections and disease. Since the discovery of the virus in the early
80’s, relentless efforts have been made to find an effective therapeutic regimen that will be
curative. Currently, even with combined use of multiple potent drugs, HIV remains incurable,
partly due to challenges in reaching and maintaining therapeutic drug concentrations in viral
reservoirs in the lymph (nodes and tissues) that are unable to be cleared by the host immune
system.
Advancements of many effective drug substances have led to the development of highly
active antiretroviral therapies (HAART) composed of single or multiple oral drug combinations.
These orally given combination anti-retroviral therapeutics (cART), generally composed of two
or three drug substances, are designed to maximally suppress HIV replication by targeting
multiple viral replication checkpoints such as, reverse transcriptase (RT), protease, and/or
integrase (often referred to as integrase strand transfer inhibitor or INSTI). With the worldwide
implementation of HAART, the lifespan of a HIV+ patient has increased significantly from less
than 1 year to a median of 77 years in the United States, as of 2020. However, HIV+ patients
can enjoy virus free survival if these oral medications are taken chronically and daily. This
requirement for taking daily pills for life and livelihood often leads to pill fatigue in people living
with HIV. Treatment interruption and non-adherence to the prescribed daily dosing leads to viral
rebound, drug resistance, disease progression to acquired immune deficiency syndrome (AIDS),
and premature death. So, while modern one-pill-a-day dosing has been demonstrated to save
lives, WHO reported that in 2021 approximately 1.5 million individuals were newly infected
with HIV; and more than half-a-million (~650,000) people died from the virus.
To address these issues, the development of HIV drugs with long-acting (LA) pharmacokinetic properties aimed
to increase dosing intervals have gained significant interest. The typical approach involves
selecting water insoluble HIV drug derivatives that exhibit longer terminal half-life in the blood
to produce an injectable dosage form that will sustain drug levels for weeks-to-months. These
hydrophobic LA medicines are typically manufactured with polymeric excipients to form small
drug crystals that retain their native crystalline states to improve water solubility. However, by
nature, nanocrystalline chemical species are in a metastable state and tend to reverse to a more
stable larger structure of drug in a polymorphic crystalline form. Other technologies and methods
have also been described to produce long-acting drug formulations: (1) conjugation of drug
molecule to erodible bio-polymers that release the drug molecule as it detaches from the polymer
over time, (2) encapsulation into polymeric particles that are biodegradable (e.g. PLGA or PLA);
or hydrogel for slowly releasing encapsulates drug molecules, (3) encapsulating into lipid
vesicles, silica, clay and other carriers, and (4) grinding of large drug crystals in insoluble
suspension with polymeric excipients to form small, nano-crystalline drug product that slowly
dissolve upon injection. These approaches, intended to produce long-acting and sustained
release or controlled drug-release, require cumbersome and time-consuming chemical
modification to derive preferred hydrophobic derivatives of the parent drug molecules.
Furthermore, some of these encapsulation processes may require removal of unencapsulated
materials, or involve mechanical milling processes which could introduce contamination, heat induced-degradation, increasing cost and production risks. To avoid and/or minimize such risks
while producing a long-acting, stable, scalable, and reproducible drug product, we have
developed and characterized a colloidal drug formulation, which enables the transformation of a
single short-acting, orally active HIV drug, dolutegravir sodium, into long-active colloidal
suspension (DTG-CS). DTG-CS particles exhibit long and extended plasma drug concentrations
to overcome the requirement of daily oral dosing. This colloidal suspension is stabilized by lipid
excipients to produce the DTG-CS particulate (d ~ 2 µm) product in suspension. When given
subcutaneously to non-human primates (NHP), the plasma DTG concentrations and its presence
over time provide sustained HIV viral suppression out to four months. Collectively, this data
suggests that DTG in DTG-CS warrants consideration for preclinical and clinical development as
a long-acting drug formulation for the treatment of HIV
Combining multiple observations to improve our understanding of forest-snow interactions and inform forest management
No full textThesis (Ph.D.)--University of Washington, 2023Many regions of the world rely on snowmelt from seasonal snowpacks for water resources. In the Northern Hemisphere, half of the seasonal snow zone overlaps with forests which interact with both snowfall and snow on the ground to influence total snow storage and water avaibility. This dissertation expands observations of forest-snow interactions to inform global modeling of canopy-snow interception in Chapter 2 and inform forest management in Washington State in Chapters 3 and 4. In previous work, we identified the need for global meteorological variable thresholds that determine canopy-snow unloading to reduce the need for site specific parameter calibration of unloading models. Thus, in Chapter 2 we create a dataset of canopy-snow unloading observations from timelapse photography at three different sites and combine them with meteorological data to determine what variable thresholds determine snow unloading across climates. Our results identify four primary unloading regimes that vary the thresholds for wind and temperature dependent unloading by climate and shortwave radiation. Furthermore, our unique dataset can be used for future model development and evaluation. In Chapter 3, we used aerial snow-on lidar from NCALM over 63 km2 of the Eastern Cascades of Washington State, USA, to quantify the effects of forest cover and topography on snow depth in this climate transition zone. We found that topographic position and canopy cover matter for snow depth in the Eastern Cascades, where the most snow at all elevations is found in topographically shaded gaps. We also found that forest cover is particularly important in predicting snow depth in warmer, low elevation terrain. In Chapter 4, we collect, process, and analyze drone lidar data before and after forest treatments on Cle Elum Ridge over a 3 km2 area in this low elevation zone of the Eastern Cascades to determine how forest treatments for fire resiliency impact hydrologic resiliency. We found that forest treatments on north-facing aspects increase snow storage in this climate transition zone compared to treatments with greater solar exposure which do not significantly affect snow depth. Thus, forest thinning and especially canopy-gap creation, on north-facing slopes provides a viable path forward for managing forests for both fire and hydrologic resilience in this climate zone
Productivity assessment of two kelps, Saccharina latissima and Alaria marginata, at varying seawater depths
No full textClimate change now affects virtually all forms of life, disrupting the foundations existence on
Earth. Major reductions in greenhouse gases are vital, but mitigation strategies to reduce extreme
impacts must be implemented now. Importantly, the healthy functioning of the ocean is the
ultimate reservoir of stability for living beings. Anthropogenic emissions are raising ocean
temperatures and acidification beyond its immense buffering capacity. Mitigation efforts must
include kelp forest restoration and ocean aquaculture. This in situ experiment examined
Saccharina latissma and Alaria marginata kelps to assess their productivity in assimilating
carbon relative to growing depth. Light played an important role, due to attenuation with depth.
Future research should work to optimize species mix and spatial configurations, over longer
durations
Literacy's Displacements: Toward Transnational Orientations to Writing and/as Translation
No full textThesis (Ph.D.)--University of Washington, 2023Scholars adopting transnational orientations to writing and literacies seek to understand the tensions of the global and the local in everyday meaning making activities. Recently, this scholarship has moved away from accumulation models of researching and assessing literacy, in which the acquisition of new languages and literacies necessarily leads to gain and/or operates toward neoliberal teleologies of global progress. Similarly, this dissertation seeks to locate relationships and knowledges writers foster when engaging in translations across genres, modalities, and language representations to the side of externally imposed progress outcomes, commissioned translations, and written artifacts. Through critical and often collaborative ethnographic inquiry, this dissertation locates these relationships across transnational trajectories of migration and translation in contemporary Central Asia, including regions in Northern Qazaqstan (outside of major metropolitan areas) historically under-represented in literacy scholarship. I ask how we might attune our approach to transnational literacies to locate moments of friction and displacement generated by both seismic and micro-moments of sociolinguistic change. Through emphases on labor issues, language and migration policies, and language reclamation efforts, this dissertation further responds to calls by scholars in the region to consider both the sociomaterial and sociolinguistic consequences of language change