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What Benefactors Want: Social Movement Patronage in Pittsburgh’s 20th century Redevelopment
No full textSome social movements rely on the support of powerful benefactors, including state agencies, philanthropic foundations, or businesses, and scholars have long examined how this support both enables and constrains movement activity. In this dissertation, I elucidate benefactors’ decision-making processes by developing the concept of patronage and a patronage argument that I assess alongside prevailing theories in three case studies in Pittsburgh’s 20th century history in which community-based movements emerged with the support of powerful benefactors to challenge urban redevelopment. In particular, I examine the foundation of Neighborhood Housing Services, Inc. in 1968, Wylie-Centre Industries, Inc. in 1971, and the Steel Valley Authority in 1986. Using formal historical methods and archival data, this study examines whether and how benefactors’ decisions to support these movement efforts were influenced by the prospects of containing insurgent movements or opportunities to advance their own interests. The dissertation concludes by spelling out patronage argument’s novel insights and new avenues for research
Exploring macrophage phenotypic and functional diversity in granulomas from Mycobacterium tuberculosis-infected macaques
No full textTuberculosis (TB) is an infectious disease that can be found all around the globe. The disease is caused by the bacteria Mycobacterium tuberculosis. In response to infection, the immune response surrounds the bacteria to stop the growth and dissemination known as a granuloma. A granuloma consists of different types of immune cells with a large fraction of the cells being macrophages. Each granuloma that develops is unique in its cellular makeup. Little is known about the diversity of macrophages that exist inside the granuloma but learning more about these cells in the granuloma can lead to targeted therapeutics, improved vaccine candidates, and an overall improvement to the understanding of TB. Using non-human primates infected with M. tuberculosis, I explored the spatial location of different macrophages populations after they were revealed by a cyclic immunohistochemistry staining process on formalin-fixed paraffin-embedded tissues and mapped their locations with software programs. Data rich images were segmented into the cell populations and spatially represented for an easier way to visualize the data. From the mapping it was seen that macrophage populations clustered into four subsets alveolar macrophage like cells, lymphocyte cuff macrophages, epithelioid macrophages, and mixed phenotype macrophages. Each subset of macrophage populations had a different spatial location in the microenvironment. Data was also analyzed through a PCA analysis to identify clusters of cells that are positive for pSTAT1 and pSMAD3. The overall results demonstrate the complexity of macrophage populations and where they localize within tuberculous granuloma microenvironment
The Harmonization of Arab Secured Transactions Law: Lessons from the American Experience
No full textThe purpose of this dissertation is to explore the means by which the Arab world might achieve an integrated secured transactions system that parallels the one that prevails in the United States, using methods of legal harmonization and taking advantage of 21st-century information technology
A pathway approach in human pregnancy to quantify the effects of phthalates on fetal health outcomes mediated by placental function
No full textExposure to chemicals presents a significant public health concern, with phthalates, a group of synthetic chemicals, drawing particular attention due to their wide usage and potential to disrupt endocrine function. Prenatal exposure to phthalates poses distinct health risks, impacting both mothers and their offspring during the critical period of hormonal development. We are pursuing the hypothesis that the placenta, a vital interface between mother and fetus, mediates in part the effects of prenatal phthalate exposure on fetal development, through the regulation of hormones such as human chorionic gonadotropin (hCG) and progesterone.
Despite accumulating evidence highlighting the disruptive effects of phthalates on placental hormones and developmental outcomes, gaps persist in understanding the underlying mechanisms and potential interventions. Epidemiological studies suffer from intractable sources of bias, while in vitro and animal models possess their own limitations. Interdisciplinary approaches that utilize birth cohorts and which probe human-specific molecular mechanism are needed to advance our comprehension of prenatal phthalate exposure and implications for developmental outcomes.
To bridge these gaps, a comprehensive approach is proposed. In the first paper, we address the question of measurement error in prenatal phthalate exposure assessment. Two methods are applied to minimize error when using concentrations measured in maternal urine as proxies for concentrations within the placental-fetal compartment. These corrections are made specifically in the context of estimating the effects of phthalates on infant genital size. The second paper utilizes a state-of-the-art 3D human placental organoid model to replicate first-trimester placental functions, surpassing the limitations of conventional cell lines. Finally, in the third paper, innovative statistical causal inference methods are employed to investigate the mediating role of hCG in the relationship between prenatal phthalate exposure and child neurodevelopment. In this paper, we apply a hypothetical intervention approach to sharpen the research question, and to offer an interpretation that can be understood in the context of population-level exposure.
By integrating diverse methodologies and interdisciplinary approaches, this research endeavors to enhance our understanding of the complex dynamics between prenatal phthalate exposure, placental biomarkers, and developmental outcomes, ultimately contributing to the broader discourse on chemical exposures and their impacts on human health
Identifying Barriers to HIV and Substance Use Service Engagement for Young Adults Involved in the Criminal Legal System
No full textBackground: The prevalence of HIV and substance use (SU) disorder is significantly higher among individuals involved in the criminal legal system than in the US generally (HIV: 1.2% vs 0.013%) (SUD: 65% vs 16.1%). Young adults (YA) are disproportionately represented in rates of incarceration, HIV, and SU disorder. Despite the high need, there are few successful interventions that link criminal legal involved (CLI) individuals to SU and HIV services, and even fewer tailored to the needs of YA. Studies have shown that YA have lower engagement and retention rates in reentry programming, but causal factors have not been identified. The purpose of this study is to identify barriers to engaging CLI-YA in HIV and SU services.
Methods: Key informant interviews were conducted with systems partners (n=8) from the criminal legal (n=3) and public health sectors (n=5). Systems partners were asked about: 1) experiences linking CLI-YA to HIV and SU services; 2) perspectives on a navigator intervention for use with CLI-YA; 3) perspectives on how a navigator intervention could be adapted in the context of the study setting. Interviews were analyzed via Inductive Thematic Analysis. Analyses were facilitated via Dedoose.
Results: Four themes impacting HIV and SU service engagement for CLI-YA were identified: 1) the health and social services landscape; 2) life chaos; 3) relationships and social support; 4) readiness to change and engage in services. Structural factors were associated with the health and social service landscape (e.g., accessibility of services) and life chaos (e.g., competing needs), social factors with relationships and social support (e.g., provider relationships), and individual factors with readiness to change and engage in services (e.g. risk perception).
Conclusions: Improving rates of HIV and SU service engagement for CLI-YA would require an approach that addresses structural, social, and individual level factors. Instituting a collaborative jail discharge process that includes jail staff, service providers, and CLI-YA could help address structural barriers to SU and HIV service engagement. Developing HIV and SU programs that include peers, build non-judgmental provider-patient relationships, prioritize autonomy, and employ principles of harm reduction could address social and individual level barriers to program engagement for CLI-YA
A Quantitative Exploration of Latinx Childbearing People’s Experiences of Obstetric Violence and Respectful Maternity Care in the United States: A Secondary Analysis of the Giving Voices to Mothers Survey
No full textObstetric violence (OV) refers to abuse or mistreatment by a health care provider or any invasive or surgical procedure performed without informed consent, that is coerced, or when procedures have been declined. OV stands in contrast to Respectful maternity care (RMC). This dissertation explores factors associated with OV and RMC and to what extent the intersectionality of nativity, parity, and history of social risk predict OV and RMC among Latinx childbearing people.
This is a secondary analysis of the Giving Voices to Mothers (GVtM) survey Latinx subsample which included 292 Latinx respondents across the United States. I employed logistic and linear regressions to assess relationships between socio-demographic variables obstetric characteristics intersectional composite variable and experiences of OV and RMC. A modified Mistreatment (MIST) index measured OV and the Mothers on Respect index (MORi) measured RMC. The intersectional composite consisted of all combinations of nativity, parity, and history of social risk.
Findings show that hospital births were significantly associated with greater likelihood of OV (OR=11.85) and lower MORi scores (Coeff = -6.74). A history of social risk also raised the odds of OV (OR=4.65). Lower MORi scores were associated with lack of support during labor (Coeff=-12.61), and operative/instrumental births (Coeff = -8). The intersectional composite variable, adjusting for delivery location, explains about 27% of the variation in respect scores and demonstrated a high level of discriminatory accuracy in predicting obstetric violence. However, it is not clear from this analysis which individual characteristic in the intersectional composite drives these effects.
This study confirms the role of the hospital environment in driving OV and impeding RMC, underscoring the need to address structural factors driving OV and RMC. These include, for example, re-thinking training for medical professionals, re-evaluating polices that contradict the tenets of RMC and creating accountability structures to address OV. This study also calls for ensuring access to different birthing models and support during labor and delivery. Lastly, this study demonstrates that an intersectional lens results in models with good predictive power for OV and RMC. Future studies should focus on marginalized identities and ensuring statistical power to thoroughly explore these phenomena
Clinical Implications of Integrating Cognitive Processing Therapy (CPT) at the Residential Level of Eating Disorder Care (RTC) For Adults with PTSD
No full textEating disorders (EDs) and posttraumatic stress disorder (PTSD) have a well-documented relationship with a comorbid presentation being common among patients. However, there is a substantial gap in research addressing the simultaneous treatment of PTSD and EDs. ED symptoms are often more severe with a comorbid diagnosis made with PTSD. Cognitive processing therapy (CPT) is a form of cognitive behavioral therapy centered around working through a patient’s experience through twelve structured, therapist-led sessions with a specific agenda attached to individual sessions. The current gap in research regarding the impact of simultaneous ED and PTSD treatment has a public health significance through the negative impact PTSD has on symptom severity and recovery. Identifying treatments that target PTSD can have significant long-term effects on ED patients with this comorbid diagnosis.
The objective of this preliminary study is to explore the benefits of integrating CPT in the treatment of ED patients with PTSD at a residential level of care (RTC). PTSD Checklist for the DSM-V (PCL-5) scores, which monitor changes in PTSD symptoms through a self-reported survey, were tracked from admission to discharge, as well as before each individual CPT session. Participants (n = 289) are adults who received simultaneous residential treatment and CPT at Monte Nido & Affiliates between January 2019 and December 2022. Statistical analyses indicate an improvement in PCL-5 scores between admission and discharge, with a 7.405±18.897 change in scores (p < 0.001)
The Epidemiological and Clinical Characteristics of Infection-Related Falls in Older Adults: A Review of Literature
No full textFalls are a critical public health issue among older adults, often resulting in significant morbidity and mortality. This review of literature investigates the relationship between falls and infections in older adults, aiming to elucidate the underlying mechanisms and identify strategies for management and prevention. This review reveals that COVID-19, influenza and influenza-like illnesses, coexisting systemic infections, urinary tract infections, and HIV/AIDS are infections associated among older adults who experience falls. The interaction between older adult falls and infections can lead to a multitude of adverse outcomes, including prolonged hospitalizations, functional decline, and increased healthcare costs. Recognizing the public health significance of this association, efforts to implement targeted interventions, including early detection and appropriate treatment of acute infections, medication review to mitigate polypharmacy-related risks, and multifactorial fall prevention strategies, are imperative to reduce the burden of falls and improve the quality of life for older adults. This review discusses the importance of taking a multidisciplinary approach in addressing infection-related falls in older populations and has implications in optimizing preventive measures and interventions tailored to this vulnerable demographic
Exploring the Cross-Sectional Association Between Metropolitan Residence and Preterm Birth in Black Individuals Using the National Survey of Family Growth
No full textPreterm birth is one of perinatal health’s most significant, intractable problems. It is associated with morbidity for both the newborn and the birthing person throughout the life course. Compounding the issue of preterm birth are the large health disparities between racial groups in the United States, with Black women experiencing preterm birth at higher rates than their White counterparts. Recent research has suggested the role of environmental factors in preterm birth risk, but there is no consistent evidence for the role of urbanicity or rurality in preterm birth. Thus, the main objective of this analysis was to describe and compare the prevalence of Black preterm births by metropolitan status using the National Survey of Family Growth (NSFG) 2017-2019. We also explored whether maternal age, education level, poverty status, health insurance coverage, or marital status explain an association between metropolitan status and preterm birth. The data were analyzed using bivariate analysis and logistic regression, including adding covariates to the model to assess their impact. There were no statistically significant associations between metropolitan status and preterm birth in the unadjusted (OR: 1.02; CI: 0.56-1.87) or fully adjusted (OR: 0.97; CI: 0.54-1.73) models. The role of urbanicity in preterm birth risk among Black women needs to be explored further by incorporating covariates that measure structural risk factors such as discrimination and reproductive health policy landscape, as well as doing more within-group analysis to understand better and ameliorate this significant public health problem
Exploring the Experiences of Patients with Rare Disease in Pennsylvania
No full textThis thesis explores the experiences and barriers facing patients with rare diseases in Pennsylvania, utilizing data from the Pennsylvania Rare Disease Advisory Council's 2020 Rare Disease Needs Assessment Survey. The study examines how respondents' demographic factors, including race, gender identity, insurance type, and rare disease type, correlate with their experiences regarding diagnostic timelines, healthcare spending, and perceptions of timely diagnosis.
Analysis of demographic data unveiled that a significant majority of respondents hailed from urban counties (73.3%) and primarily reported a single primary diagnosis (74.5%). The prevalence of private commercial health insurance (41%) among respondents outweighed government-funded sources such as Medicaid or Medicare (14.6%). Although the data offered a comprehensive snapshot of respondents' demographic landscape, it also exposed potential biases in representation, notably among minority racial groups and individuals from the transgender and nonbinary community in Pennsylvania.
Chi-square tests conducted on various facets of rare disease patients' experiences yielded significant insights. The analysis uncovered a notable relationship between diagnostic time intervals and the number of incorrect diagnoses, emphasizing the critical role of accurate diagnoses in patients' diagnostic journeys. However, no statistically significant relationship emerged between age and annual spending on rare disease care, indicating a multifaceted interplay of factors influencing healthcare spending across different age groups.
Further exploration looked into the correlation between gender identity and perceptions of timely diagnosis, revealing potential disparities in patient experiences based on gender identity. Additionally, the analysis of health insurance types and perceptions of timely diagnosis illuminated differences in healthcare access and perceptions among individuals with varying insurance coverage.
Overall, this study provides valuable insights into the challenges and needs of rare disease patients in Pennsylvania, underscoring the importance of tailored support, enhanced diagnostic processes, and equitable access to healthcare services. The findings highlight the necessity for patient-centered care, comprehensive diagnostic strategies, and targeted interventions to address the diverse needs and challenges encountered by rare disease patients throughout their diagnostic odyssey. Future research and interventions grounded in these findings have the potential to enhance support and outcomes for individuals with rare diseases, not only in Pennsylvania but also globally