University of North Carolina Hospitals

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    95038 research outputs found

    Local News and State Legislative Effectiveness

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    Natural differences in media markets in the United States lead to differences in specificity and intensity with which newspapers cover individual legislators. Although past work examines how local media influences the performance of whole legislatures, less is known about influences on individual state legislators. I hypothesize that the mere prospect of intense, specific coverage induces legislators to work harder on their constituents’ behalf. Using local newspaper circulation data from the News Deserts Database and the Alliance for Audited Media, I investigate whether state legislators perform better when they represent a media market suited to generate intense and specific coverage of their legislative activities. Indeed, I find that such legislators are more effective on average. Although these legislators do not introduce more bills than others, the bills they introduce are more likely to earn legislative approval and become law.Master of Art

    The Role of Deliberation in the Theory of Normativity

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    In this dissertation, I argue that deliberation is normatively important. The first four chapters center around the defense and application of a deliberative constraint on reasons––viz., the idea that reasons must be able to feature in deliberation. In Chapter 1, I argue that there is a deliberative constraint on reasons. In Chapter 2, I argue, on the basis of a deliberative constraint, that there is no norm of truth on belief. In Chapter 3, I argue, on the basis of a deliberative constraint, that there are no reasons for emotions. In Chapter 4, I argue that some philosophers have taken the consequences of a deliberative constraint too far: in particular, accepting a deliberative constraint does not rule out pragmatic reasons for beliefs, for, I argue, transparency is false. I depart from the deliberative constraint in Chapter 5. In Chapter 5, I argue that our deliberative perspectives bear on what we ought to believe.Doctor of Philosoph

    Modeling Causal Systems to Foster Epistemic Development, Systems Thinking, and Civic Practice

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    Modern challenges like pandemics, famine, and climate change are incredibly complex. Addressing these problems requires a holistic approach which honors this complexity. This dissertation features three studies which examine the use of models of causal systems to support systems thinking, epistemic development, and civic participation. The models featured in this study differ from typical models encountered in science classrooms in that they are interdisciplinary, drawing together ideas from fields of inquiry like science, economics, and sociology to create a holistic understanding of the problems being investigated. Each study investigates a different facet of how these models might support student learning. The first explores the epistemic knowledge students draw upon which influences how they view modeling as a practice. The second studies the cognitive activity used by students to accomplish systems thinking tasks while using these models. The third investigates how creating these models might be used to foster high-quality decision-making. This study concludes with a synthesis of ideas across chapters and a discussion of future research possibilities. Overall, the collective findings of this dissertation suggest that these models present several advantages for science educators who wish to help students use science to better understand complex, modern problems.Doctor of Philosoph

    Mobility and Burial Along the Way of Saint James: Embodiment and Ephemerality at the Silo of Charlemagne

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    In this dissertation, I examine how signs of mobility and locality are inscribed both in burial practices and on the skeleton itself through an investigation of mortuary practices, skeletal assessments of demographic traits, pathological indicators, and isotopic ratios in an assemblage from the Silo of Charlemagne in northern Iberia. My primary aims were to identify local versus nonlocal individuals, analyze dietary variations by mortuary context, and investigate how mobility and diet manifested in skeletal pathologies associated with deleterious health changes across the lifespan. The individuals included in this research have life histories linked to the historic Way of Saint James pilgrimage route, to military conflicts at the end of the 18th century and beginning of the 19th century, and ultimately to the settlement of Roncesvalles, which despite its small size has long served as a nexus of mobility and a gateway into the Iberian Peninsula due to its strategic location at the mouth of a traversable mountain pass. The recovery of various artifacts confirms the presence of both religious pilgrims and soldiers, and isotopic findings show that the Silo of Charlemagne served as a key mortuary site for nonlocal individuals. These analyses identified significant dietary variation linked to occupation and identity, reflecting diverse and stratified resource access. Pathological evidence highlights the health challenges faced by soldiers, including physical stress and potential nutritional deficiencies stemming from their labor-intensive and mobile lifestyles. These results underscore the role of territorial and sociopolitical relationships during late 18th and early 19th century military conflicts, including the diverse composition of conscription and volunteer armies in the region.This biocultural study illustrates the complexity of entanglements between health, mobility, and social identities, ultimately concluding that the embodiment of social forces in the human skeleton takes a multiplicity of forms that are observable through several media. Broader implications of this work resonate with contemporary issues, such as the health impacts of displacement and limited healthcare access among mobile groups (such as refugee populations). The study ultimately emphasizes the need for further investigation into the intersections of disease, isotopic uptake, and mobility in past and present contexts.Doctor of Philosoph

    Technology, Innovation & Healthcare Markets in Low- and Middle-Income Countries: A Study of Telemedicine in India

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    While Covid propelled the growth of telemedicine in low- and middle-income countries (LMICs), little is understood about the effectiveness of telemedicine or how it can be leveraged to plug the provider shortage and increase access to care in these settings. This dissertation aims to further the understanding of telemedicine by studying different paradigms of telemedicine in India. In the first study, I explore the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during the Covid pandemic. Through in-depth qualitative interviews conducted with practitioners, I find that providers are highly intrinsically motivated to volunteer to address the healthcare needs of the underserved, and value non-pecuniary rewards towards maintaining regular voluntary engagement online. In the second study, I investigate the impact of a large-scale telemedicine network that operated several models of telemedicine during Covid on Covid health outcomes. When differentiated by timing of adoption, I find that late adopters of the intervention demonstrate effects as large as 23 percentage points on Covid positive case rates. The model that triaged already diagnosed Covid patients through the available health infrastructure demonstrated the biggest impact with an effect of 23 percentage points on the Covid positive rate and of 6 percentage points on the fatality rate. In the third study, I evaluate two interventions – a mandate and a platform update – designed to sustain telemedicine adoption. While the mandate has an immediate impact on the number of teleconsults conducted, this effect does not sustain over time. The platform update, which solvers for ease of use, results in a decrease of 0.6 teleconsults per doctor in the week following the rollout. However, this trend reverses over time, resulting in an increase of 0.03 teleconsults per doctor per week in the following weeks. The findings underscore the potential of telemedicine to address inequities in medical provider availability and access to healthcare in LMICs. However, mechanisms to sustain provider engagement outside of times of crisis are important. Non-pecuniary incentives and solving for ease of use of platforms are potential instruments to sustain provider engagement with telemedicine.Doctor of Public Healt

    Serving the Country: A Critical Discourse Analysis of National Media About School Meal Policies from 2020-2024

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    One of the most common daily activities for children across the United States (U.S.) is a school meal. These meals are operated through the National School Lunch Program (NSLP) and School Breakfast Program (SBP). Scholars have described school meal programs as highly political, as they represent the interests of different entities. Since their inception, the NSLP and SBP have undergone periods of growth and stagnation, reflecting the political and cultural shifts in the United States. This study focuses on the period of time surrounding the Coronavirus Disease of 2019 (Covid-19) pandemic as a unique sociohistorical period in which to explore the NSLP and SBP as well as school meals in general. Grounded in a Foucauldian perspective, this dissertation was designed to critically analyze the discursive construction of the occupation of school meals. A central concept is that of power as a productive force that allows certain knowledge to be produced and represses other rationalities. Everyday activities, such as school meals, are therefore constructed through power/knowledge relationships which can be analyzed through discourse. A major objective of Critical Discourse Analysis (CDA) is to explore how certain rationalities are mobilized to construct problems and solution frames. In this dissertation, I analyze national media to identify discursive threads that surfaced and interacted with one another in the field of school meals. The results reveal an intersecting web of reasonings that reflect underlying discursive threads of nationalism, neoliberalism, and healthism. The findings are described in three sections that together offer a nuanced narrative of school meals in America from 2020-2024. Section One is entitled “A Crisis to Our Pledge” and contains three segments that explore the occupation of a school meal during Covid-19. Section Two is entitled “Who Deserves a School Meal” and examines subjectivities constructed in the discourse of school meals. Finally, Section Three is entitled “The Construction of Americans” which further details the positions of school meal workers and the value of children learning adult roles through school meals. My interpretations provide a rich analysis of the political and politicizing occupation of school meals in the U.S. during and after the Covid-19 pandemic.Doctor of Philosoph

    MARTIAL MATERIALITY, MASCULINITY, AND THE EXPRESSION OF KNIGHTLY IDENTITY 1350-1425

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    This dissertation is a contribution to the study of late medieval English and French martial aristocratic culture. It examines the relationship between knights, their material world, and their notions of masculinity. To do so, it traces the form and function of two major categories of chivalric objects: plate armor and noble animals. In texts and images, these were the things by means of which members of the arms-bearing elite reified their homosocial bonds: to be a man in this world was instinctively to know how to act in accordance with the meanings of one’s equipment and animals. This dissertation utilizes chronicles, chivalric biographies, funerary documents, illuminated manuscripts, tomb effigies, and surviving examples of armor, among other texts and objects, to bridge the divides between technical studies, military history, and gender history. Ultimately, it argues that the struggle of aristocratic self-fashioning, the agon of becoming a man, stabilized chivalric culture during the tumult of the Hundred Years War. The attitudes toward, and functions of, armor and animals in a martial context facilitated patterns in masculine expression that tended to transcend social and military disruptions. Chapter One serves as a foundation for the rest of the dissertation: it establishes the social and military roles of knights, illustrates the kind of armor they wore, and examines how elite animals were bred and used. Chapter Two analyzes how knights asserted their masculinity in battle, and how narratives of battle reveal chivalric notions of “victory” and “defeat” centered on individual deeds and remembrance. Chapter Three examines the role of armor and animals in spectacles of violence, and how knights manipulated the gaze of their peers in duels, jousts, and hunts. Finally, Chapter Four argues that armor and animals, as gifts, forged homosocial bonds between fighting men and facilitated transformations in the knightly life cycle. Taken together, these episodes and artifacts illustrate how and why armor and animals enabled masculine self-fashioning; from a knight’s childhood to senescence they shaped his body, defended him in battle, exhibited him in spectacles, and accompanied him in death.Doctor of Philosoph

    BRIDGING MENTAL HEALTHCARE GAPS: TARGETED DEPRESSION SCREENING IN AFRICAN AMERICAN FAITH-BASED COMMUNITY

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    Problem Description: Major Depressive Disorder (MDD) significantly impacts African American communities, exacerbated by barriers such as stigma, healthcare mistrust, and limited access to care. African Americans experience higher severity and prolonged illness but receive fewer screenings and treatment services compared to other populations.Purpose: This quality improvement project aimed to bridge mental healthcare gaps by implementing a targeted depression screening protocol using the Patient Health Questionnaire-9 (PHQ-9) in an African American faith-based community to improve early detection and resource connection.Methods: A structured depression screening protocol was developed and conducted over four weeks in a local church setting, utilizing a multidisciplinary Wellness Team comprising Psychiatric Mental Health Nurse Practitioners, Registered Nurses, Licensed Clinical Social Workers, and support staff. Participants completed the PHQ-9, received immediate psychoeducation, and received appropriate mental health resources and follow-up care based on their scores.Results: Of 81 registered participants, 45 (56%) attended screenings. Most participants (60%) exhibited minimal depressive symptoms, while 24% required follow-up for moderate to severe depression. Workflow modifications addressed clinician availability, improving responsiveness and efficiency. Clinician interaction averaged 22 minutes per participant, adapting to the participant's needs. Challenges included logistical constraints from concurrent church activities and resource distribution omissions.Conclusions: Implementing a structured depression screening within faith-based settings is feasible and effectively identifies depression severity and care needs. Addressing logistical challenges and enhancing community engagement could improve screening uptake and sustainability, reinforcing faith-based organizations' critical role in addressing mental health disparities.Doctor of Nursing Practic

    Modular Methods for Continuous and Efficient Adaptation of Large Language Models

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    This thesis investigates modular methods as alternatives for achieving continuous and efficient adaptation in Large Language Models (LLMs). The immediate goal of this research is to develop and empirically validate novel modular techniques that overcome the inherent limitations of monolithic LLM architectures. The broader goal is to advance the conceptual understanding and practical realization of modularity as a foundational principle for building a new generation of adaptable and scalable AI systems. The modular methods explored in this dissertation are structured around the core concepts of continual learning, efficiency, and composition. First, this work establishes the foundations of modularity in continual learning. Through ExSSNeT (Exclusive Supermask Subnetwork Training), I demonstrate how modular subnetworks and masking can enable specialization and mitigate catastrophic forgetting in sequential learning scenarios, laying the groundwork for more complex modular architectures. Extending this investigation, the thesis explores continual learning for code generation models, showcasing the versatility of modular prompting techniques, and introducing PP-TF (Prompt Pooling with Teacher Forcing) as a novel adaptation strategy for this domain. Second, the thesis addresses the critical aspect of efficiency in modular LLMs. ComPEFT, a novel compression technique for Parameter-Efficient Fine-tuning (PEFT) updates, is presented as a solution to drastically reduce communication and storage overhead. This method leverages sparsification and quantization to create highly efficient modules, enabling the practical deployment of modular adaptation strategies at scale. Lastly, this research culminates in the exploration of advanced modular composition for LLMs. Ties-Merging, a novel model merging technique, is introduced to resolve interference and enhance the performance of statically composed expert models. Moreover, we study the scalability of model merging methods and find that they can be used to adapt LLMs at scale. Furthermore GLIDER (Global and Local Instruction-Driven Expert Router) is proposed as a dynamic routing mechanism that leverages LLM-generated instructions to enable intelligent and adaptive composition of expert modules at inference time, showcasing a pathway to scalable and generalizable modular LLM systems. In summary, this dissertation advances the field by establishing a comprehensive framework for modular methods, demonstrating their potential to enable continuous and efficient adaptation, and offering a compelling vision for a future where AI systems are inherently more flexible, scalable, and adaptable to the ever-evolving demands of real-world applications.Doctor of Philosoph

    Just War Theory and the Failed Promise for Peace

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    In the background of contemporary just war theory often lies an implicit promise: just war theory offers a better path towards limiting war, both its occurrence and devastation, than its alternatives realism and pacifism. In this vein, Michael Walzer writes “the restraint of war is the beginning of peace.” Here I present a challenge to the promise regarding the occurrence of war, drawing on work in the philosophy of science as well as the realist tradition in international relations. I begin by highlighting the link between cause and prevention, captured in Kenneth Waltz’s insight that understanding how to best achieve peace requires understanding the causes of war. I argue that just war theorists have an overly atomistic picture of the causes of war, behind which hide several false structural assumptions. The consequence is, at least in its current form, just war theory cannot guide us towards peace.Master of Art

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