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Confronting Bureaucracy: Examining Systemic Challenges of Caring for Children with Medical Complexity at Home
No full textThesis advisor: Judith A. VesseyBackground: The number of children with medical complexity (CMC) cared for by parental caregivers is increasing in the United States. Studies reveal parental caregivers experience significant caregiver burden, often attributed to the disease management required by CMC. However, literature has also identified numerous systemic challenges that arise while caring for CMC at home. The impact of systemic challenges on parental caregiver burden has not been examined, thus, the purpose of this dissertation is to explore the relationship between these systemic challenges and parental caregiver burden. Methods: Three studies were completed to explore this relationship. An integrative review of literature from 2014-2023 was completed to identify systemic challenges within the home care system and whether parental caregivers attribute burden to these challenges. A case-control secondary analysis of the National Survey of Children’s Health compared levels of burden between parental caregivers and parents of children without medical complexity as they relate to systemic challenges. Lastly, a qualitative descriptive study was conducted with parental caregivers living in Massachusetts to examine their experiences of caring for CMC. Results: The integrative review of 10 articles revealed a dynamic and interconnected relationship between systemic challenges and parental caregiver burden. The secondary analysis comparing 1,352 parents (n = 676 parental caregivers) revealed significant associations and increased odds of experiencing burden among parental caregivers while navigating systemic challenges. Finally, three themes capturing the experiences of parental caregivers (N=11) emerged from collected qualitative data; lack of discharge preparedness causes emotional distress, care becomes increasingly complex creating new unanticipated challenges, and the psychological toll of parents assuming provider role. Conclusion: The findings from this dissertation provide data-driven evidence to support a relationship between systemic challenges of caring for CMC and parental caregiver burden. This greater understanding of parental caregiver experiences highlights the need for a more holistic perspective in evaluating the care of CMC at home such that systemic challenges, and not a child’s medical needs, are the focus of future exploratory, intervention, and health policy work.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing
Reevaluating the Ventral and Lateral Temporal Neural Pathways in Face Processing: Deep Learning Insights into Face Identity and Facial Expression Mechanisms
No full textThesis advisor: Stefano AnzellottiThere has been much debate over how the functional organization of vision develops. Contemporary theories that are inspired by analyzing neural data with machine learning models have led to new insights in understanding brain organization. Given the evolutionary importance of face perception and the specialized mechanisms that have evolved to support evaluating it, examining faces offers a unique way to study a dedicated mechanism that shares much of its organization in ventral and lateral neural pathways with other social stimuli, and provide insight into a more general principle of the organization of social perception. According to a classical view of face perception (Bruce and Young, 1986; Haxby, Hoffman, and Gobbini, 2000), face identity and facial expression recognition are performed by separate neural substrates (ventral and lateral temporal face-selective regions, respectively). However, recent studies challenge this view, showing that expression valence can also be decoded from ventral regions (Skerry and Saxe, 2014; Li, Richardson, and Ghuman, 2019) and identity from lateral regions (Anzellotti and Caramazza, 2017). These recent findings have inspired the formulation of an alternative hypothesis. From a computational perspective, it may be possible to process face identity and facial expression jointly by disentangling information for the two properties. This hypothesis was tested using deep convolutional neural network (DCNN) models as a proof of principle. Subsequently, this is then followed by evaluating the representational content of static face stimuli within ventral and lateral temporal face- selective regions using intracranial electroencephalography (iEEG). This is then extended to investigating the representation content of dynamic faces within these regions using functional magnetic resonance imaging (fMRI). The results reported here as well as the reviewed literature may help to support the reevaluation of the roles the ventral and lateral temporal neural pathways play in processing socially-relevant stimuli.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Graduate School of Arts and Sciences.Discipline: Psychology and Neuroscience
Decent Work and its Association with Mental and Physical Health among Latina Immigrants:
No full textThesis advisor: Betty S. LaiLatina immigrants comprise more than half of the 12.3 million immigrant women who work in the United States (U.S.) (American Immigration Council, 2017). However, they do not benefit from the same wages and workplace protections (i.e., decent work) as U.S.-born women. Latina immigrants are overrepresented in essential but low-wage jobs that are less likely to offer benefits like employee-sponsored health insurance and paid time off (U.S. Bureau of Labor Statistics, 2021). Yet, there is minimal research on the relationship between decent work and the physical and mental health of Latina immigrants, specifically. This is concerning, given that decent work is associated with positive physical and mental health outcomes (Duffy, Kim, et al., 2019; Duffy et al., 2021; Kozan et al., 2019). Using psychology of working theory (Duffy et al., 2016), LatCrit theory (Valdes, 1997), and mujerista psychology (Bryant-Davis & Comas-Díaz, 2016) as its frame, this study sought to address this gap in the literature through the examination of three research aims: identifying barriers to decent work specific to Latina immigrants (Aim 1); examining the relationship between decent work, physical health, and mental health (Aim 2); and testing moderation of these relationships by parental status (Aim 3). This study used a sub-sample of participants (n=591) from the 2019 National Health Interview Survey (NHIS), a nationally-representative survey conducted annually by the Centers for Disease Control and Prevention. Participants in the sub-sample were first-generation Latina immigrants between the ages of 18 and 78 (M = 43.92) who worked in the past week. The majority of the sub-sample identified as Mexican-American (55.30%) and non-U.S. citizens (52.12%). Data were analyzed using structural equation modeling (SEM). Results indicated that economic constraints significantly predicted decent work (Aim 1). Contrary to hypotheses, decent work did not predict physical health or mental health (Aim 2). Finally, residing with minor children strengthened the relationship between marginalization and decent work (Aim 3). Limitations and future directions for research, policy, and clinical practice are discussed.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Lynch School of Education.Discipline: Counseling, Developmental and Educational Psychology
Development of Orthogonal Catalytic Click Processes That Forge Functional Linkages:
No full textThesis advisor: Amir H. HoveydaChapter One: Development of a New Catalytic Click Reaction Involving Nitriles and Allenes (CuPDF)Catalytic click reactions, although small in number, have made a profound impact on chemistry research, including the fields of drug discovery, biological chemistry, and materials science. What is much needed are additional catalytic reactions that bring about the union of commonly occurring and robust functional groups, are mutually orthogonal to those that exist and offer a function other than connecting two fragments. We have developed a catalytic click process that connects a nitrile and a monosubstituted allene in the presence of commercially available B2(pin)2 and a readily accessible Cu(I) complex. The modification stage involves alkene isomerization by base and condensation with a hydrazine and both processes are performed in situ. The resulting linkages contain a robust diazaborinine that is fluorescent. We demonstrate that the click process, which we have named copper(I)-catalyzed phenoxydiazaborinine formation (CuPDF) is mutually orthogonal to copper(I)-catalyzed azide–alkyne cycloaddition (CuAAC) as well as sulfur-fluorine exchange (SuFEx). These click reactions can therefore be used for efficient synthesis of sequence-defined oligomers that may contain modifiable linkages and peptide-drug conjugates. For applications in aqueous media, we have also developed, copper(I)- and palladium-catalyzed quinoline formation (Cu/PdQNF). These latter processes generate fluorescent connectors as well.
Chapter Two: Development of a Catalytic Click Reaction Involving Ketones and Allenes (CuAKA)
We have developed another click reaction, this time bringing about the union of a ketone and, similar to CuPDF, a monosubstituted allene and B2(pin)2. We label this click reaction copper(I)-catalyzed allene–ketone addition or CuAKA. As a consequence of shared reactants, identifying catalysts that would allow CuAKA and CuPDF to be mutually orthogonal was at the center of our investigations. Our studies resulted in the identification of copper(I) complexes that can be used to perform a click reaction on a nitrile or a ketone. Furthermore, we found that mutual orthogonality can be achieved between CuAKA and CuAAC using an amino phosphine–Cu(I) catalyst. Computational and kinetics studies were performed that shed light on the origins of catalyst-controlled chemoselectivity. Importantly, similar to CuPDF, CuAKA can be performed in aqueous media.
Chapter Three: Preparation of Multi-drug Conjugates with Mutually Orthogonal Click Reactions
We show that with CuAAC, CuPDF and CuAKA, three mutually orthogonal click processes can be efficiently merged to assemble complex molecules efficiently with no protection/deprotection needed. With CuAKA, similar to CuAAC and CuPDF, being also orthogonal to SuFEx, a four-armed core molecule may be used in a similar fashion. A central finding in this part of study was the discovery that CuAKA, similar to CuAAC but unlike CuPDF, can be used to link molecules that contain acidic protons, such as phenol or a carboxylic acid moieties.
Chapter Four: Controlled Rupture of CuAKA-Generated Linkages
A distinct attribute of CuAKA is that it forms a linkage that is cleavable under mild aqueous oxidative conditions. We show that the tertiary hydroxy group accelerates the oxidation of the nearby C–B bond within the connector to generate a -hydroxy ketone that undergoes a retro-aldol reaction to effect rupture. We show that an aryl linker between the ketone and the carrier molecule, such a bile acid or a cell-penetrating peptide (CPP) may be used to achieve the steric and electronic parameters that are needed for optimal clicking and clipping rates. To demonstrate applicability, we used CuAKA was used for efficient linking of camptothecin, an anti-cancer agent with low selectivity, to a ketone attached to unprotected penetratin, a CPP. The ensuing release of the payload proceeded readily in a 68 mM aqueous solution of hydrogen peroxide at 37 °C with control experiments indicating that a proximal lysine residue accelerates the retro-aldol reaction. Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Graduate School of Arts and Sciences.Discipline: Chemistry
Beyond Trust: Socioeconomic, Experiential, and Perceptual Drivers of Healthcare Utilization in a High Disease Burden, Low-Income Country
No full textThesis advisor: Thomas M. CreaFew studies have examined drivers of healthcare trust and vaccine hesitancy in the context of low- and middle-income countries (LMIC) where healthcare systems are most fragile. This study focuses on healthcare trust and vaccine hesitancy in Sierra Leone, a country that has a history of infectious disease outbreaks. This study examines drivers and impacts of healthcare mistrust in caregivers of children and Covid-19 vaccine intention and behavior both for caregivers and for their children. This study also examines current community members trust in healthcare providers, including doctors, nurses, and traditional healers. This study uses two data sets: quantitative data for Aim 1 and Aim 3 come from a two-wave longitudinal NICHD-funded study (#R01HD096699; PIs: Thomas M. Crea, PhD, MSW and John S. Schieffelin, MD) and includes a sample of EVD-infected (n=222), EVD-affected (n=208), and control children (n=233) and their caregivers (n=663). Qualitative data were used for Aims 2 and 3 and were collected in August of 2023 in Freetown, Sierra Leone, as part of a study funded through Boston College Vice Provost Office (PI: Oladoyin Okunoren, LCSW). This study has three specific aims: AIM 1: Examine the influence of mental health and healthcare trust on Covid-19 vaccine behavior and intention among caregivers. AIM 2: Explore healthcare perceptions, utilization, and trust in Sierra Leone, and implications for vaccine uptake and intention. AIM 3: Explore community and healthcare worker perceptions of traditional healers within healthcare interventions before and after EVD.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Graduate School of Social Work.Discipline: Social Work
Community Agency in Boston's Chinatown: Chinatown's Resilience Against the Urban Renewal Craze of the Late 20th Century
No full textThesis advisor: Michael GlassThis thesis analyzes how community agency plays a role in uplifing resilience and hope to Boston Chinatown's community during the twentieth century of mass urban renewal, developments, and gentrification, threatening their physical, mental, and social space. Ethnic enclaves like Chinatown were common targets of urban development, often defended by arguments of economic prosperity and urban growth. The reality of urban projects in Chinatown was the transformation from a residential home into a tourist attraction. To take back a sense of agency within Chinatown, residents turned to art as a way to reestablish their presence and voice among wealthy urban planners. Th ecommunity initiative to revitalize cultural identity and power through community and art demonstrates Chinatown's resilience and its journey towards becoming a more antifragile community.Thesis (BA) — Boston College, 2024.Submitted to: Boston College. Morrissey School of Arts and Sciences.Discipline: History.Discipline: Departmental Honors
Surviving Reality TV: The Evolution of Competition and Camaraderie in a Surveillant World
No full textThesis advisor: Kristin PetersonThis thesis examines the behavioral evolution within the reality TV competition Survivor, which, in its forty-seventh season, has been on air since 2000. Focusing on the general attitudes and strategies of players, this research uses surveillance theory and the concept of learned behaviors as a framework for analysis. A Critical Content Analysis of three key seasons—the first, thirty-third, and forty-sixth—highlights shifts in dialogue, camaraderie, individuality, generational work ethic expectations, and the criteria for victory. The findings reveal that while the show has become outwardly emotional and vulnerable compared to its aggressive origins, player strategies have grown increasingly complex and covert. Under the guise of kindness and influenced by heightened surveillance, subliminal betrayals now outmaneuver overt confrontation. These dynamics manipulate audiences to perceive the gameplay as less competitive, when in reality, modern Survivor demands a more critical understanding of layered social strategies and the show's evolving competitive landscape.Thesis (BA) — Boston College, 2024.Submitted to: Boston College. Morrissey School of Arts and Sciences.Discipline: Communication.Discipline: Departmental Honors
Entrepreneurial Rhetoric for Institutional Transformation: The Logics of "Reinventing government" in the United States (1993-2000)
No full textThesis advisor: Mary Ann GlynnThesis advisor: Jean BartunekOrganizational scholars use the concept of institutional logics to define and distinguish between multiple co-existing institutions that constitute the diverse cultural landscapes of contemporary societies. Research on institutional logics has devoted considerable attention to understanding how actors use rhetoric associated with distinct institutional logics as tools of institutional transformation. However, prior research has not typically examined rhetoric aimed at transforming institutions with broad societal impact, such as public or governmental institutions, which limits the generalizability of empirical findings. This dissertation renews the logics literature’s original emphasis on societal institutions and offers necessary clarification on how the central logics of two major societal institutions, the state and the market, may change in relation to each another through the rhetorical agency of state actors. In two studies, the dissertation examines the dynamics between the state logic and the market logic embedded in the rhetoric of the Clinton administration on its high-profile federal management reform, known as “Reinventing Government,” and related discussions in the United States Congress over a seven-year period (1993-2000). Study 1 focuses on how the administration constructed and revised rhetoric to justify replacing the prevailing state logic with the market logic to key stakeholders. Study 2 focuses on how the rhetoric of congressional lawmakers expressed heterogeneous legitimacy criteria that differed in priority given to the state logic versus the market logic. The studies provide convergent findings that suggest logic replacement is an unlikely form of institutional change at the societal level of analysis; however, the state logic may change by combining with elements of the market logic to form new layers of content over time.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Carroll School of Management.Discipline: Management and Organization
Close Calls and Near Misses: Sustaining Engagement in Dangerous Work
No full textThesis advisor: Elizabeth RouseWorkers are increasingly exposed to dangerous work environments that pose significant risks to their well-being. Scholars have sought to improve these environments through illuminating practices that organizations use to increase safety. Yet not all dangers can be eliminated. Since workers continue to face dangers, it is important to understand how workers sustain engagement in dangerous work over time. I explore this question through an ethnography of snowmakers – individuals who make snow at ski resorts. My findings shine a light on two important factors in sustaining engagement in dangerous work: auxiliary routines and enactments of masculinity. First, I found that snowmakers sustained engagement in dangerous work by actively altering their work experiences through two primary auxiliary routines: play and respite. These routines created positive experiences in the workplace, yet paradoxically often made the work more dangerous. Second, I found that the introduction of female snowmakers led men to take different paths to navigate enactments of masculinity in the presence of women by either protecting women through enactments of masculinity through chivalry or supporting women. By focusing on the processes that enable workers to sustain engagement in dangerous work, this dissertation illustrates how workers balance danger and positive work experiences through auxiliary routines and how workers navigate enactments of masculinity in dangerous male-dominated workplaces. In doing so, this research builds new theory in dangerous work, auxiliary routines, and masculinity literatures.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Carroll School of Management.Discipline: Management and Organization
An Interactive Theory of Power Projection: Naval Power Shift, The Contagion Effect, and Alignment Opportunity
Full text linkThesis advisor: Robert RossMilitary balance of power and geographical proximity are two key factors that shape thelikelihood of war and peace in the realist paradigm. However, the empirical cases associated with the leading sea power and a naval challenger sometimes are not congruent to systemic anticipations of both the balance of power theory and hegemonic shift theories. Why do the leading sea power and a challenger fight a war despite naval power disparity and geographical distance? Conversely, how do these powers arrive at a strategic settlement even with naval power parity and geographical proximity? More practically, under what conditions are the U.S. and China more likely to avoid or end up in a war as China’s naval overtake looms large in the Asia-Pacific? To address these questions, I construct a mid-range theory, An Interactive Theory of Power Projection, that incorporates the geographical dimension of power projection in determining the outcome of naval power shifts. Specifically, I conduct comparative historical case studies of the two Anglo-French dyads (1856-1870/1882-1904) and the U.S.-Japan dyad (1921-1941) with a goal of developing a theory to apply to U.S.-China relations. At root, I argue that the outcome of a naval power transition is contingent upon two conditions: (1) the interactive dynamics of a challenger’s expansion and the leading sea power’s expectation about its contagion effect on the first line of maritime defense; and (2) whether alignment opportunity, shaped by third common threats and available allies in the theaters of the power transition, is open or closed.
The contagion effect refers to three kinds of possibilities in the event of a challenger’s occupation: (1) an occupation will become a stepping stone on which a challenger further expands into the adjacent first line of maritime defense; (2) an occupation will produce a negative second-order effect on the other, possibly distant, first line of maritime defense; (3) an occupation will undermine or remove local allies on the first line of maritime defense. I argue that while bilateral resource-extraction capacities initiate or end a naval arms race, it is the interactive dynamics of geographical power projection as well as alignment opportunity in the theater of the naval challenge that bring a conflict to the fore and determine its outcome. These findings carry policy implications for U.S.-China relations and U.S. foreign policy.Thesis (PhD) — Boston College, 2024.Submitted to: Boston College. Graduate School of Arts and Sciences.Discipline: Political Science