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Opioid overdose deaths have increased substantially over the past fifteen years. I characterized the experience of the medical community and measured the multi-level factors influencing opioid prescribing within the context of legislation and clinical decision support interventions.
My content analysis of letters to the editor in JAMA demonstrated that physicians seek to balance pain management and the adverse effects of opioids. Physicians took ownership of their role in the epidemic but called upon the government and community to help address the issue.
My interrupted time series study revealed that legislation resulted in patients with acute musculoskeletal injury (n=12,918) having 17.7% increased frequency (p<0.001) of receiving a perception for <7 days, climbing to 77.1% of all opioid prescriptions. Physician and facility characteristics accounted for 30% and 9% of the observed variation, respectively.
A clinical decision support intervention lowered the percent of patients with chronic musculoskeletal conditions (n=1,290,746) receiving an opioid by 1.6% (p=0.0002) but had no effect on dose. Practice accounted for 24% of the variation in safe opioid prescribing scores.
Collectively, this research presents a sophisticated and nuanced understanding of the multi-level factors which influence guideline-concordant opioid prescribing. These data can inform tailored interventions and guide decision-making and policy.
About 1.1 million Americans were living with HIV in 2019, with the total lifetime cost to treat a single person with an HIV infection estimated to be around $501,000. PrEP, a pill taken daily by mouth, contains antiretroviral drugs and is highly effective in preventing the acquisition of HIV. Even though PrEP coverage in the US improved from 9% in 2016 to 18% in 2018, considerable disparities in PrEP prescriptions exist in different geographic, racial/ethnic, and age groups. Existing metrics to measure PrEP overestimates PrEP coverage. Moreover, previous studies conducted at the national and state levels often fail to capture disparities in PrEP use within the county and cannot be used by county public health officials to conduct targeted interventions. This dissertation establishes an evaluation framework for HIV prevention by measuring PrEP usage at subcounty levels.
The PrEP coverage increased annually throughout the study period in the county. The G2ZMC PHI had a significant gradual effect of about nine PrEP patients every month. The results of this dissertation quantified and identified opportunities for improvement in PrEP use in underserved groups. This work can be extended to other counties and provide a foundation for similar studies on other emerging infectious diseases.
Supramolecular aggregates can have specific nanostructures that give them a variety of functionalities, making them useful for many applications in energy, catalysis, medicine, biotechnology and other scientific fields. These functional nanostructures are built via the self-assembly of building blocks with particular physicochemical properties. Different molecular interactions participate in the self-assembly processes such as metallic, ionic, van der Waals forces, electrostatic, hydrophobic, H-bonding, and π- π stacking. Therefore, the building blocks for self-assembly are molecules that are pre-designed to supply these interactions in a given environment; in addition, they can provide a desired functionality.
Polyhedral oligomeric silsesquioxane (POSS) is a promising scaffold to be used as delivery system. When covalently linked to a photosensitizer, POSS has an influence on the self-assembly behavior of the photosensitizer, modifying its properties, potentially enhancing its efficacy toward photodynamic therapy (PDT).
In this Thesis, I describe my work on the study of polyhedral oligomeric silsesquioxanes (POSS) porphyrin derivatives as building blocks, their self-assembly and application in photodynamic therapy (PDT). We envision that the chemical tunability of POSSs can be used as a promising option to improve the delivery and performance of photosensitizers.
The schooling and leadership experiences of Black girls and women are overlooked as they are often intertwined with the experiences of Black males or White women. Historically, the academic, mentoring, leadership, and mental health needs of Black girls and women have been neglected and challenged in educational settings. The purpose of this qualitative study was to explore the racialized lived experiences of Black girls and women in K-12 schools from a student and Black school administrator perspective. The findings from this dissertation indicate the following: a) Black girls and women lack support and nurturing at all levels in education (student, AP, and principal); b) Black girls and women need spaces in schools to feel supported, collaborate and create actions and policies on how to best meet their needs; c) the mental health of Black girls and women must be considered sacred and protected at all times; and d) Black girls and women need to be included in decision making processes at all school levels.
Educational Research, Measurement, & Evaluation (ERME)
A Project in Humanizing Inquiry (San Pedro & Kinloch, 2017), this qualitative dissertation study combined in-depth interview with a LatCrit framework to story the journeys of three Latinas into teaching. Data analysis underscored the layered racialized systems of oppression that marked the three women’s educational identities and professional trajectories. Notable forms of oppression included deficit-laden interactions within schools and schooling that largely predicted the individual women as failures. Likewise, much more intimate familial messaging framed teaching as a dead-end career. With the support of key mentors and through their own determination, the three women, nevertheless, were able to make sense of who they were, what they valued, and the teachers they would ultimately become. Implications for diversity-oriented teacher education and research are presented.
The motivation of this research is to build systems that precisely control displacement in the presence of external load (both linear and rotation force). To achieve this, two experimental platforms have been created. Those instruments incorporate actuation stages, rotary apparatus, and rotary encoder and displacement sensors. During experiments the temperature of the stage and the environment are recorded. Characterization of these processes necessarily requires generation and monitoring of forces and measurements of displacement, rotation, and environmental temperature. The actuator methods include thermal expansion and piezoelectric (PZT) actuation, and the displacement sensing includes optical knife-edge and capacitive gage sensors, and the rotation sensing includes digital camera and rotary encoder. An automated control strategy comprising PID closed loop control (for heating) and On/Off switching between air and mist control (for cooling) is described for the thermal expansion actuator. The translation stage of this study produces a displacement range of 100 µm and 200 µm (using 240 W and 480 W power sources) in the presence of preloads up to 1 kN. Depending on the power source used, the root mean square (rms) controller error at steady-state is within 15 nm (240 W) and 35 nm (480 W). The PZT actuation stage has a displacement range of 16 μm with a resolution of sub-nanometer, and this is used to generate a penetration force between a sample and a diamond indenter tip and this force passes through, and is measured by the load-cell stage. Numeric experiments have been performed with penetration depths from 200 nm to 2000 nm and with penetration forces between 20 mN to 200 mN.
