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Meeting the Member Where They Are: Community-Based Strategies to Advance Toward Equitable Outcomes in Medicare Advantage Plans
No full textHealth equity is a broad objective that is fueling the healthcare industry as it strives to incorporate social determinants of health factors into the already complex and individualized clinical care for patients. This literature review explores the intersection of healthcare equity, public health, and publicly governed healthcare systems; while offering a thorough examination of the ways in which community-based interventions can increase access to high-quality resources and care, reducing the detrimental effects of social and environmental barriers on health. Current healthcare disparities and inefficient clinical patterns require innovative strategies, individual and population-specific approaches, and targeted interventions that can best be done through well-integrated health systems and government-funded payers. With a specific focus on Medicare Advantage's disruptive potential in the healthcare landscape, this study investigates the lens through which embracing patient-centered, community-focused strategies that acknowledge and address the external determinants of health, thereby fostering better health outcomes and advancing health equity. This review aims to inform policymakers, payers, and health plans to implement effective strategies for improving healthcare access and outcomes for underserved or restricted service areas
Assessing the impact of showerhead design choices on consumer exposure to drinking water-associated pathogens that can cause infections in the immunocompromised
No full textRespiratory infections from drinking water-associated pathogens that can cause infections in the immunocompromised (DWPIs) are responsible for >145,000 human infections annually and cost the US economy billions. Cases are rapidly increasing in the United States as susceptible populations increase (e.g., those at either age extreme or currently living with a weakened immune system), and currently outpace illness caused by regulated fecal-borne pathogens. DWPIs thrive in building plumbing biofilms, with several recent studies showing a clear link between the strains of DWPIs found in household water and the strains infecting people. Although DWPI exposure can occur through a variety of pathways, inhalation of shower water associated aerosols are most likely a source of infection. Because DWPI proliferation occurs mainly in building plumbing, studying how consumer choices at the point of use (e.g., showerhead type and water use patterns) affect users’ potential DWPI exposure is critical to helping vulnerable groups make informed decisions about their plumbing to reduce health risks.
This work focused specifically on quantitively assessing the impacts that different showerhead setups had on the microbiome and DWPI exposure risk posed by shower water and shower-water associated aerosols. Through full-scale shower and biofilm reactor experimentation, the findings from this work have shown that antimicrobial additives such as silver do not reduce DWPIs in the shower system, and that showerhead material choice, flow rate, and changes in water use habits impact the microbiome. An especially important finding from this work is that showerhead age (days of use) is a major factor in explaining microbial dynamics in shower water and associated aerosols and consequently should be considered when developing new DWPI microbial risk assessments. Overall, this body of work provides consumers and building managers with unbiased and empirical data to empower and inform them to make choices that are best for their specific situations, as well as provide valuable insights for DWPI mitigation
Ecology, Society, and Imagination in Oyamada Hiroko's The Factory and The Hole
No full textTwo of Oyamada Hiroko’s best-known works are her proletarian debut novella The Factory (Kōjō, 2013) and her Akutagawa prize-winning novella The Hole (Ana, 2014). My thesis focuses on representations of the unseen forces at play in everyday life in Oyamada’s novels. Oyamada constructs multispecies worlds in which capital, patriarchy, and the environment are intertwined. I examine how The Factory represents alienation and precarity in the current neoliberal economy. The factory is depicted as the background for a multispecies assemblage in which all beings are affected by capitalism. In shifting focus to marginalized beings, Oyamada challenges notions of modernity which conveniently ignore their existence. I discuss capitalism’s extension into the home in The Hole. Women’s reproductive roles in the family serve to support models of production based on the myth of the male breadwinner. Oyamada shows how women are covertly nudged into traditional gender roles, and how wildness offers a potential alternative
Militia and Civilian Death in Civil Wars
No full textCivil wars are devastating conflicts that often result in significant casualties, with civilians being the most affected. However, most studies on civilian victimization in civil wars tend to treat civilians as passive participants, overlooking their agency and the choices they make in these conflicts. Militia groups, one form of civilian response to conflicts, have been attracting more and more public and academic attention in recent years. While emerging studies of militia groups have provided valuable insights on how and why they are formed, little attention has been paid on their impacts on the dynamics of civil wars. By conducting a detailed analysis of four militia groups in the Chinese Civil War, the dissertation argues that militia groups could play a significant role in shaping the dynamics of civil wars and can have a considerable impact on civilian victimization. However, their behavior and interactions with other actors, such as states and rebels, are not well-understood. To address these research gaps, the dissertation presents a comprehensive theoretical framework for conceptualizing militia groups and proposes a new typology of militias. The framework establishes a boundary for the definition of "militia" and identifies two defining variables of militia-state interactions: interest alignment and militia containment. It categorizes militias into four types: death squads, defensive patrols, stationary bandits, and crowds. Each type is characterized by different degrees of interest alignment with the state and militia containment. I apply case studies to further illustrate the validity of my theory on militias and civilian victimization in civil war comparing to competing theories. By examining the empirical data and employing typological theory, the dissertation explores how the proposed theoretical framework could apply in four civil war cases: the Ivory Coast Civil War, the Indonesian Civil War, the Peruvian Civil War, and the Sri Lanka Civil War
Explicit Learning in Developmental Stuttering
No full textStuttering is a neurodevelopmental disorder characterized by overt speech disfluencies and significant adverse impact on quality of life. Atypical cortico-basal ganglia-thalamocortical loops are theorized to contribute to the onset and development of stuttering. Children who stutter (CWS) also have less efficient executive function skills and reduced neural connectivity in brain regions that support executive function compared to children who do not stutter (CWNS). These brain regions and skills are known to support learning. Dual-learning systems (DLS) models propose two category learning systems. The explicit system supports learning rule-based categories and is scaffolded by executive function. The procedural system supports learning information-integration categories implicitly using feedback and reward. Based on previous findings in CWS that suggest differences in cortico-basal ganglia-thalamocortical loop connectivity and executive function skills, which may suggest reduced learning performance and inefficient learning strategy use in CWS, we investigated auditory and visual explicit category learning in CWS using DLS models. Sixty-three 7–12-year-old CWS (N = 31) and CWNS (N = 32) completed three online sessions which included a battery of speech, language, cognitive, and auditory and visual explicit category learning tasks. Children learned to categorize auditory (sounds) that varied along temporal and spectral modulation dimensions and visual (lines) stimuli that varied along spatial frequency and orientation dimensions. There were no significant group differences in learning accuracy, reaction times, or learning strategy use. Both groups of children had higher accuracies in the auditory modality at the beginning of learning but showed more improvements in accuracy across learning blocks in the visual modality. Performance on tasks that measured inhibition and cognitive flexibility skills was similar for CWS and CWNS. Inhibition skills did not predict learning performance. Higher cognitive flexibility skills predicted significant improvements in accuracy across learning blocks in the visual modality for both CWS and CWNS. In the auditory modality, higher cognitive flexibility skills predicted improvements in accuracy across learning blocks in CWNS only. Taken together, these findings suggest that explicit category learning is intact in CWS and stronger cognitive flexibility skills in CWNS support learning across modalities, a relationship that is less robust in CWS
For the love of God: a look at religious students’ beliefs on LGBTQ+ issues
No full textThis thesis analyzes interviews conducted with 15 college students who self-identify as religious, specifically as members of what are known as Abrahamic traditions: Christianity, Judaism, and Islam. Through analyzing participants’ responses to inquiries regarding issues such as his paper attempts to fill a gap in the field of religious and queer studies research by specifically focusing on young adults, a group that is chronically understudied when it comes to ethnographic or other research-based interviews. During the interviews, I asked participants a series of questions, delving into their religious practices, backgrounds, and beliefs alongside questions on political identity specifically focused on perceptions of LGBTQ+ people and issues.
The college students that participated in these interviews supported the notion that their religious identity, regardless of which religion the individual practiced did mold their attitude toward LGBTQ+ issues. Consistent themes included the value of community, non-judgment, respect, complexity in inter- and intra-faith dialogues, and what I have deemed the “I’m not an expert” dilemma. This paper will also take a look at the minority of participants who identify as politically Christian, as well as those who identify as both religious and queer, to understand how certain political or other identities impact young adult beliefs on religion and sexuality. Taken together, these interviews provide a compelling example of the complexity of thought that can be found in the vibrant religious communities on college campuses
The effect of speech sound disorder on attention in developmental stuttering
No full textStuttering is a communication disorder in which individuals have disruptions in the forward flow of speech. Speech sound disorders are communication disorders in which individuals have difficulty with articulation and phonology. Both disorders have been associated with less effective or efficient attentional processes; however, the relationship between attention, stuttering, and speech sound disorders is unclear. The current study aimed to investigate selective auditory attention in children who stutter (CWS) with and without speech sound disorders (SSD) using event-related brain potentials (ERPs). Seventy-seven children ages 4-8 years participated, including children who do not stutter (CWNS), children who do not stutter with SSD (CWNS-SSD), children who stutter (CWS), and children who stutter with SSD (CWS-SSD). Children completed a selective auditory attention paradigm where they were asked to attend to one narrative and ignore (unattended) another. ERPs were recorded to linguistic and nonlinguistic probes overlaid on the attended and unattended stories and ERP mean amplitudes elicited by probes in the attended and unattended conditions were compared. No significant differences were found in neural processes for attention between CWS and CWNS or between CWS and CWS-SSD. However, for the linguistic probe, children without SSD exhibited larger anterior neural responses while children with SSD exhibited larger central responses, suggesting differing neural distributions for selective auditory attention based on the presence of SSD. Results suggest that while the presence of stuttering did not impact selective auditory attention, the presence of SSD may contribute to differential patterns of neural engagement during an auditory selective attention paradigm, highlighting the complexity of attentional processes in childhood SSD
Modulating the toxicity of polyamines in Staphylococcus aureus
No full textUSA300 is a recently discovered strain of community-acquired Methicillin-resistant S. aureus (CA-MRSA) that has been shown to be more virulent and transmissible than any other strain of MRSA. Like other strains of S. aureus, USA300 possesses resistance to β-lactam antibiotics; however, USA300’s increased potency is owed to its resistance to the naturally occurring polyamines spermine and spermidine. While spermine and spermidine are toxic to most strains of S. aureus, USA300 encodes a gene known as speG that confers resistance to these compounds. Because the target of spermine and spermidine is cytosolic and speG is a cytosolic protein, polyamine toxicity is thus limited by cellular uptake, with polyamine resistance additionally being conferred from within S. aureus cells.
This thesis thus serves to determine whether polyamine uptake can be increased to improve toxicity against USA300 clones. We have shown that unsaturated fatty acids such as palmitoleic acid, oleic acid, and linoleic acid are highly toxic to USA300 clones, presumably through the fatty acids’ incorporation into membrane phospholipids resulting in membrane disruption. In turn, we have shown that treatment of speG-deficient USA300 clones with combinations of palmitoleic acid, oleic acid, or linoleic acid with spermine results in higher levels of killing of these clones than the use of a fatty acid or spermine treatment alone. We have further shown that the treatment of wild-type USA300 clones with combinations of palmitoleic acid, oleic acid, or linoleic acid with the synthetic polyamines Bis(hexamethylene)triamine (HMTA) and Tris(3-aminopropyl)amine (TAPA) results in higher levels of killing of these clones that the use of a fatty acid or synthetic polyamine treatment alone. Additionally, this thesis has identified the S. aureus-encoded gene fakA as a contributor to exogenous unsaturated fatty acid toxicity, presumably due to fakA-dependent incorporation of exogenous fatty acids into the bacterium’s cellular membrane that could lead to increased membrane destabilization and the potential for increased polyamine uptake. As S. aureus is a skin and soft tissue infection, this thesis’s findings provide evidence that a combination of unsaturated fatty acids and polyamines could serve as the key components of a future topical treatment for USA300-caused infections
Analyzing Accessibility and Suitability of Online Krabbe Disease Resources
No full textBetween 25 and 30 million Americans are affected by rare diseases. Krabbe disease (KD) is a neurodegenerative leukodystrophy affecting approximately 1 in 100,000 births in the United States. KD has been screened for in select states since 2006 but was recently suggested for addition to the Recommended Uniform Screening Panel. Following a diagnosis, parents frequent the internet to learn about specific medical conditions and necessary medical follow-up. Because disparities in management and prognosis are often associated with health literacy levels, patient education materials (PEMs) must be accessible to their intended audiences. This study aimed to assess the accessibility and suitability of online KD resources, using results to provide recommendations for resource improvement.
A Google search was conducted utilizing common search terms parents may use to identify patient-centered online KD resources. Twelve online KD resources were analyzed. These resources were compared against an author-developed list of essential information for patients and families. Readability was assessed using the Flesch-Kincaid Reading Grade Level and the Simple Measure of Gobbledygook Reading Grade Level, available through Readable.com. Suitability was measured by two reviewers utilizing the Suitability Assessment of Materials (SAM) Tool and the Patient Education Materials Assessment Tool (PEMAT) to reach a consensus assessment for each resource. Resources were classified as ‘superior’, ‘adequate’, or ‘not suitable’ based on the SAM Tool and rated on understandability and actionability using the PEMAT.
Most selected resources had readability grade levels above the recommended sixth to eighth grade reading levels for PEMs, ranging from 7.4 to 14.6. Eleven out of twelve (91.7%) resources were rated as ‘adequate’ or higher using the SAM Tool. PEMAT understandability scores ranged from 55.05% to 94.12%, and actionability scores ranged from 0% to 83.33%.
While resources were easy to navigate, they struggled using common language to make the information understandable to the broader population, utilizing graphics appropriately, and promoting interactivity and presenting concrete next steps based on given information. Future resource development should focus on implementing action steps parents can take after diagnosis and improving readability by using common terminology and graphics to increase understanding
Characterizing Hospital-Associated Clostridioides difficile Infection: A Retrospective Descriptive Review and Bed Tracing Analysis
No full textDescription of problem: Clostridioides difficile is a common hospital-associated infection that is defined as an urgent threat to public health by the CDC (CDC, 2019). Risk of C. difficile infection (CDI) is highest in elderly and immunocompromised individuals, as well as those with recent antibiotic exposure and frequent or prolonged hospitalization. This essay aims to analyze an increase in hospital-associated CDI (HA-CDI) cases in an urban, acute care hospital from June 2022 – August 2023.
Aims: 1) Characterize and describe HA-CDI patients to identify trends, exposures, and risk factors among these patients. 2) Analyze the movement of HA-CDI patients to determine if shared environments or exposure to other infected patients may have contributed to transmission in the hospital setting.
Methods: Data was collected from the electronic health records of HA-CDI patients during the study period, including risk factors, testing, demographics, and admissions information. Variables were assessed for their frequency and significance among these patients. Contact tracing was performed to determine if shared environments may have contributed to transmission and identify plausible exposures between patients.
Results: This study included 48 patients with 50 reported cases of HA-CDI. Antibiotics were the most common risk factor exposure (88.0%). Patients were found to be younger but with more severe comorbidities than expected. There was a significant relationship identified between enteric tube insertion and toxin positivity. Contact tracing revealed that 83.3% of patients had at least one plausible exposure to another HA-CDI patient on the same unit preceding infection. Shared rooms were not implicated as common sources of transmission.
Conclusions: Hand hygiene, adherence to transmission-based precautions, and thorough cleaning practices are vital to the prevention of HA-CDI. Adherence to testing protocol may reduce unnecessary CDI testing. The significant relationship between enteric tubes and toxin positivity requires further study but may highlight a risk of infection during tube insertion or manipulation.
Public Health Significance: Findings from this study will inform infection prevention practices at the facility of study. Understanding HA-CDI risk factors specific to this facility allows for identification of at-risk patients and the implementation of targeted interventions to reduce the incidence of CDI and HA-CDI