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Full-Text Articles in Medicine and Health Sciences

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis Jan 2024

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Senior Theses

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the …


The Education Prescription: Exploring The Potential Of Patient Education To Reduce Mental Health Issues In Hormonal Contraceptive Users, Maria Abraham Jan 2024

The Education Prescription: Exploring The Potential Of Patient Education To Reduce Mental Health Issues In Hormonal Contraceptive Users, Maria Abraham

Nursing | Senior Theses

The many birth control options available impact a woman’s life, as hormonal contraceptives are commonly used but often misunderstood. These contraceptives, which contain progestin only, or estrogen and progestin combined, can come in various forms such as pills, implants, IUDs, injections, the vaginal ring, and skin patches. They offer benefits such as reduced menstrual cramps and ectopic pregnancy risk. However, they may lead to adverse side effects which can include increased blood pressure, nausea, headaches, breakthrough bleeding, and a higher risk of blood clots, with research indicating a potential link between oral contraceptive use and a decline in the user’s …


Promoting Parental Comfort To Facilitate Conversations On Adolescent Sexual Health And Behaviors, Angelina Jolie Banes, Lauren Liddell Jan 2024

Promoting Parental Comfort To Facilitate Conversations On Adolescent Sexual Health And Behaviors, Angelina Jolie Banes, Lauren Liddell

Nursing | Senior Theses

This thesis proposal will investigate the impact of a comprehensive digital sexual health education program on the comfort levels of parents and teens when discussing sensitive topics such as pregnancy and sexually transmitted infections (STIs). The research is guided by Orem’s Self-Care Deficit Nursing Theory, which emphasizes the need to assess and address individuals’ self-care deficits, including the ability to engage in safe and informed sexual behaviors. The research design is a quantitative, quasi-experimental study with a one-group pre and post-test design. The sample consists of 50 parents and 50 teens from Marin County, who will participate in an online …


Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos Jan 2024

Empowering Low-Income Women With Breast Cancer: Promoting Acupuncture At Community Health Fairs, Katrina Ramos

Nursing | Senior Theses

While research has explored the positive effects of acupuncture on cancer and cancer treatment symptoms, a notable gap exists in understanding its impact on lower-income populations. These individuals encounter barriers to accessing acupuncture, such as limited availability, cost, and provider knowledge. This longitudinal study aims to assess the impact of community health fairs, featuring acupuncture information for breast cancer and chemotherapy-induced symptoms, on the acceptance and utilization rates of acupuncture among low-income women with breast cancer. Collaborating with the Women’s Cancer Resource Center and a local non-profit integrative cancer care clinic in Oakland, we will conduct a three-day health fair …


Breastfeeding Support In Your Pocket: Evaluating The Impact Of A Mobile App On Maternal Success, Maygan Brandt Jan 2024

Breastfeeding Support In Your Pocket: Evaluating The Impact Of A Mobile App On Maternal Success, Maygan Brandt

Nursing | Senior Theses

Background: Breastfeeding has well-known benefits for both the nursing infant and the birthing parent. It bolsters the newborn immune system, and reduces the risk of future health conditions in both parties. Due to these advantages, several health organizations internationally recommend exclusive breastfeeding until 6 months of age. However, only a fraction of infants in the United States meet this goal each year. Improved rates and duration of exclusive breastfeeding will lead to better long-term health outcomes for patients. The use of smartphone applications for breastfeeding education and support has not been thoroughly researched. Objective: This thesis explores the feasibility of …


Unlocking Vr Magic: Duration Of Anxiety Relief For Pediatric Needle Procedures, Anna Angelica Guzman Mendoza Jan 2024

Unlocking Vr Magic: Duration Of Anxiety Relief For Pediatric Needle Procedures, Anna Angelica Guzman Mendoza

Nursing | Senior Theses

There have been various studies that show the effectiveness of virtual reality (VR) being used as a non-pharmacologic and distraction method on school-aged children ranging from 6-12 years old. Despite this research, there has not been a follow-up with the use of VR and its duration of effect between each patient visit within this certain population. This study focuses on measuring the participants’ anxiety and pain levels during the needle-related procedure. The assessment tools that will be used to measure these important variables are the Children’s Fear Scale and Wong-Baker’s FACES scale. The participants of this study will be placed …


Furry Friends & Brighter Futures: Enhancing The Life Skills Of Toddlers With Autism Through Animal Assisted Therapy, Abigail Rosales Tolentino Jan 2024

Furry Friends & Brighter Futures: Enhancing The Life Skills Of Toddlers With Autism Through Animal Assisted Therapy, Abigail Rosales Tolentino

Nursing | Senior Theses

Autism Spectrum Disorder (ASD) encompasses a broad spectrum of challenges that impact social interaction, communication, and behavior. While Applied Behavior Analysis (ABA) stands as a common therapeutic approach, there is a growing recognition of the need for personalized interventions. Animal Assisted Therapy (AAT) emerges as a promising avenue for enhancing social interactions. This study focuses on the utilization of dogs in AAT for toddlers aged 12 to 36 months with confirmed ASD diagnoses. The experimental group will undergo a combined intervention involving standard ABA therapy alongside weekly AAT sessions, whereas the control group will receive standard ABA therapy alone. Pre- …


A Pulse For Progress – Examining The Efficacy Of Best Nursing Developmental Care Practices For Children With Congenital Heart Disease At Risk For Developmental Delay In The Pcicu: A Prospective Quasi-Experimental Cohort Study, Jasmyn Jansen Jan 2024

A Pulse For Progress – Examining The Efficacy Of Best Nursing Developmental Care Practices For Children With Congenital Heart Disease At Risk For Developmental Delay In The Pcicu: A Prospective Quasi-Experimental Cohort Study, Jasmyn Jansen

Nursing | Senior Theses

Emerging advances in pediatric cardiovascular surgery have significantly decreased the mortality rates in infants born with critical congenital heart disease (CHD), in turn, leading to increasing prevalence in adolescence and adulthood. At the same time, developmental delays (DD) are on the rise among children with CHD. Recent research suggests that prolonged exposure to the pediatric cardiac intensive care unit (PCICU), with its environmental stressors, negatively implicates neurodevelopment raising the question, and risk, of DD. In January 2023, the American Heart Association (AHA) issued a scientific advisory calling hospitals to implement developmental care practices for hospitalized infants and young children with …


Reimagining Equitable Care: Simulation-Based Education And The Dismantling Of Implicit Bias And Stigma Of Vulnerable Populations In Hospitals, Vanessa Smith Jan 2024

Reimagining Equitable Care: Simulation-Based Education And The Dismantling Of Implicit Bias And Stigma Of Vulnerable Populations In Hospitals, Vanessa Smith

Nursing | Senior Theses

Background: Simulation-based education consists of using high-fidelity mannequins and equipment to provide a safe space for healthcare professionals to practice crucial skills within healthcare. Used within hospitals and schools, simulation most commonly surrounds practicing hands-on skills such as central line insertion, IV insertion, Ultrasound-guided procedures, code blue response, etc. However, a large portion of healthcare that is overlooked is tackling issues within patient-provider relationships. Simulation can help dismantle the negative behaviors and feelings providers push onto patients through the use of standardized patients and role-playing. By using these methods, simulation can reduce providers’ personal implicit biases and the stigma associated …


Physical And Optical Properties Of Material Used For Injection Molding, Nadia Christine Farias Machado Jan 2024

Physical And Optical Properties Of Material Used For Injection Molding, Nadia Christine Farias Machado

All ETDs from UAB

Background: This project investigates the materials used in injection molding dental resin composites which involves injecting flowable composite into a clear mold. Understanding the physical and optical properties of both the resin composite and the clear mold material is crucial for successful clinical outcomes. For the clear mold material, its translucency, curing light transmission, and rigidity are vital factors. Correlations may be present between trans-lucency and curing light transmission. For the resin composite, comparing wear, hardness, translucency, radiopacity, shrinkage stress, flexural strength, and modulus will affect mate-rial performance. Finally, the depth of cure of the material will be dependent on …


Investigating Hiv-1 Transmission To Human Cervix Using Reporter Virus Technologies, Dana Frances Indihar Jan 2024

Investigating Hiv-1 Transmission To Human Cervix Using Reporter Virus Technologies, Dana Frances Indihar

All ETDs from UAB

Around 39 million people globally are currently infected with Human immunodeficiency virus 1 (HIV-1), more than half of whom are women. HIV-1 is a retrovirus that infects and depletes an individual’s immune cells, culminating in the development of acquired immunodeficiency syndrome (AIDS) if not managed with anti-retroviral therapies (ART). Most women acquire HIV-1 through heterosexual intercourse. However, the early mechanisms and virologic determinants of HIV-1 transmission to women remain unclear. Herein, we demonstrate transmitted/founder (TF) HIV-1 representing two genetically and pathogenically distinct subtypes (A and D) in vivo have distinct replication phenotypes in an ex vivo cervical explant tissue (CET) …


Crown Fatigue Resistance And Enamel Wear Of 3d Printed Resin Compared To Lithium Disilicate, Pranit Vasant Bora Jan 2024

Crown Fatigue Resistance And Enamel Wear Of 3d Printed Resin Compared To Lithium Disilicate, Pranit Vasant Bora

All ETDs from UAB

Purpose: The purpose of this study is to compare the wear characteristics and fatigue resistance of two dental crown materials: SprintRay Ceramic Crown, a 3D-printed resin material, and IPS™ e.Max CAD, a lithium disilicate material. Methods: This study evaluates wear and fatigue characteristics of dental crowns made from Ceramic Crown (SprintRay) and IPS e.max CAD LT (Ivoclar). For fatigue testing, custom fatigue devices were utilized to subject the crowns to cyclic loading, simulating occlusal forces. The specimens underwent 100,000 cycle intervals until 1.5 million cycles at a load of 40N of fatigue loading, with inspections conducted for signs of debonding, …


Predictive Modeling Using Clinical Data And Compositional Microbiome Data, Li Zhang Jan 2024

Predictive Modeling Using Clinical Data And Compositional Microbiome Data, Li Zhang

All ETDs from UAB

This dissertation focuses on developing predictive modeling using data from two areas: clinical data and microbiome data. Compositional data in real life are mainly represented by relative proportions. With the advancement of next-generation sequencing (NGS) technology, researchers can now collect a large volume of metagenomic sequencing data, which is valuable for investigating associations between the microbiome and host diseases. Current methods for dealing with such data are either constrained by generalization or limited by application. In the first part, to address this, we propose Bayesian compositional generalized linear models for analyzing microbiome data (BCGLM). This model incorporates a structured regularized …


Functional Analysis Of Mandibular Movements In Three Different Groups Including Patients With Total Joint Replacements, Previous Orthognathic Surgery, And A Control Group, Adriana Morales Buendia Jan 2024

Functional Analysis Of Mandibular Movements In Three Different Groups Including Patients With Total Joint Replacements, Previous Orthognathic Surgery, And A Control Group, Adriana Morales Buendia

All ETDs from UAB

Purpose: To Assess mandibular movements, including mouth opening, lateral excursion, and protrusion among patients with total joint replacements and orthognathic surgery compared to healthy control participants with no known TMJ disorders. Methods: Fifty-two subjects from 18 to 66 years of age were included in this cross-sectional study, distributed in three groups: patients with total joint replacement (n = 16), patients who underwent orthognathic surgery (n=17), and healthy control subjects (n = 19) to quantitatively determine whether there is statistically significant difference among the groups regarding opening, lateral excursion, and protrusion movements. The non-invasive system SiCAT JMT+ device was used to …


Cbt And Me: A Beginning Therapist's Journey Utilizing Client Feedback, Haley Scruggs Jan 2024

Cbt And Me: A Beginning Therapist's Journey Utilizing Client Feedback, Haley Scruggs

Theses and Dissertations--Family Sciences

Cognitive behavioral couple therapy (CBCT) is a model of therapy targeting cognitions, emotional responses, and behavioral interactions between couples experiencing relationship distress. Routine outcome monitoring (ROM) is a tool that clinicians can use to track the progress of their clients in therapy from the perspective of the client. This study aimed to use MFT-PRN, a type of ROM, to gather client progress throughout CBCT treatment. Prototypical change trajectories were created in Microsoft Excel for examination of presenting problem progress, couple satisfaction, and overall relationship functioning. It was found that small data sensitivity affected the trajectories immensely, though ROM outcomes revealed …


A Multidisciplinary Approach To Managing Financial Toxicity In Oncology Patients, Katelin Muse Jan 2024

A Multidisciplinary Approach To Managing Financial Toxicity In Oncology Patients, Katelin Muse

Walden Dissertations and Doctoral Studies

Patients with a cancer diagnosis are counseled at length about the standard of care treatment options, which may include surgery, radiation, anticancer medications, and chemo/immunotherapy through an informed consent process. Unfortunately, the potential economic burden and the accompanying psychological burden is seldom discussed up front. There is a significant need for routine screening and a multidisciplinary approach to the prevention of financial toxicity for the oncology patient. The purpose of this doctoral project was to lead an interprofessional team in the development of a clinical practice guideline for routine financial screening using the Comprehensive Score for Financial Toxicity (COST) tool …


The Use Of Vascular Endothelial Growth Factor In Ligament And Tendon Repair, Caroline O'Connell Jan 2024

The Use Of Vascular Endothelial Growth Factor In Ligament And Tendon Repair, Caroline O'Connell

Honors Theses

The studies in this review have shown that VEGF increases tensile strength, decreases inflammation, and increases vascularization. In studies using exogenous VEGF, it was found that VEGF increases collagen type III fibers, which increases biomechanical strength, and improves graft revascularization. From the research, it can be concluded that endogenous injection of VEGF is more beneficial than exogenous due to endogenous not causing laxity of the connective tissue. VEGF is beneficial when compared to normal post-operative results due to it decreasing the duration of symptoms and decreasing healing time. Using VEGF injection treatments, patients can return to pre-injury activity at a …


“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto Jan 2024

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …


“I Didn't Want Them To Feel Like I Was Fragile”: A Qualitative Analysis Of Disability, Intimacy, And Sexual Culture At Yale, Mafalda Von Alvensleben Jan 2024

“I Didn't Want Them To Feel Like I Was Fragile”: A Qualitative Analysis Of Disability, Intimacy, And Sexual Culture At Yale, Mafalda Von Alvensleben

Public Health Theses

This thesis examines how Yale as an educational institutional shapes disabled students’ sexual and romantic lives. It explores the ways in which the institution's policies, culture, and physical environments influence these experiences via a qualitative and landscape analysis. The analysis was based off nine semi-structured interviews with students who self-identified as disabled from both undergraduate and graduate programs, as well as a landscape analysis that incorporates formal, journalistic style interviews with eleven Yale faculty, staff, and administrators. Taken together, this study illuminates the challenges posed by systemic ableism within the university's academic and social frameworks. It highlights the inadequacies of …


Comparing Hpv Vaccination Uptake In Democrat And Republican Us States Using Presidential Elections Voting Patterns In 2016 And 2020, Omar Guerrero Jan 2024

Comparing Hpv Vaccination Uptake In Democrat And Republican Us States Using Presidential Elections Voting Patterns In 2016 And 2020, Omar Guerrero

Public Health Theses

Abstract Objective: To investigate the association between state-level voting patterns and Human Papillomavirus (HPV) vaccination coverage in teenagers in the US. Methods: States were categorized as either Democratic or Republican based on the 2016 and 2020 Presidential election results. A paired t-test was conducted to examine the difference between vaccination coverage between the two groups. A multivariable linear regression model was conducted to examine how state-voting patterns are associated with HPV vaccination coverage after adjusting for confounding (percentage of people living in poverty, percentage of uninsured people, percentage of non-white population, and the percentage of people living in rural areas …


Reducing Nursing Documentation Burden: Evaluation Of An Electronic Health Record Optimization Plan, Jessica Collins Jan 2024

Reducing Nursing Documentation Burden: Evaluation Of An Electronic Health Record Optimization Plan, Jessica Collins

DNP Projects

Background: UK HealthCare transitioned to a new enterprise electronic health record (EHR) system, offered by Epic Systems Corporation, in June 2021. Approximately 2,000 inpatient nurses use the EpicCare Inpatient Module in the 1,086 licensed bed facilities. Compared to other academic medical centers, UK HealthCare nurses take more time documenting in this EHR inpatient module’s Basic Assessment Flowsheet (documentation burden) and have a longer delay between assessment and documentation (timeliness) potentially contributing to nursing dissatisfaction with using this new EHR.

Purpose: The purpose of this project was to evaluate the effectiveness of a phase of the Epic Nurse Well-Being Project, a …


Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce Jan 2024

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …


The Impact Of Technological Innovation On Deaf And Hard Of Hearing Communities, Mickayla Cooper Kwakye-Ndlovu Jan 2024

The Impact Of Technological Innovation On Deaf And Hard Of Hearing Communities, Mickayla Cooper Kwakye-Ndlovu

Honors College Theses

Over the past couple of decades, significant shifts have occurred in technological development. Among these advancements, the smartphone has emerged as an integral part of people’s daily lives, serving as a powerful tool for accessibility and global connectivity. This literature review explores the ways in which everyday communication technology is utilized by Deaf and Hard of Hearing (DHH) individuals and examines the impact of its development on these communities. The goal of the work is to investigate how the evolution of modern smartphones contributes to breaking down communication barriers for DHH communities. This review focuses on smartphone features that enhance …


Comparisons Of Unilateral And Limb Symmetry Indexes Between Fixed Dynamometry Testing Modes, Emily E. Frizzell Jan 2024

Comparisons Of Unilateral And Limb Symmetry Indexes Between Fixed Dynamometry Testing Modes, Emily E. Frizzell

Honors College Theses

Hamstring muscles strains are extremely common and can vary in severity. The biarticular structure of the hamstring groups is one reason that they are more susceptible to injuries. The recurrence of these injuries is also common even after they have been through a rehabilitation phase in their recovery. This project aims to compare and associate knee flexion and extension muscle performance characteristics between isometric, isotonic, and isokinetic assessment modes. These different modes of assessment will test analyze muscle performance under varying muscle lengths, movement velocities and biomechanical load modes. The data collected from this testing will be analyzed to see …


Impact Of Covid-19 On Individuals With Aphasia: Effects On Quality Of Life And Communication, Kaci L. Gammon Jan 2024

Impact Of Covid-19 On Individuals With Aphasia: Effects On Quality Of Life And Communication, Kaci L. Gammon

Honors College Theses

Speech-language pathologists (SLPs) help people with aphasia (PWA) manage their communication symptoms and become more independent by supporting them linguistically and emotionally. During COVID-19, speech and language services were not as readily available to PWA due to quarantine restrictions resulting in isolation within this population. Individuals with aphasia had to redirect and find a new way to function daily. This study explored factors that affected quality of communication and quality of life for PWA during the pandemic, including technology, living situation, timing of stroke, and speech-language pathology services. Through an online survey, PWA from across the country expressed how their …


The Art Of Healing From The Inside Out: A Memoir, Lauren Thelen Jan 2024

The Art Of Healing From The Inside Out: A Memoir, Lauren Thelen

Regis University Student Publications (comprehensive collection)

ABSTRACT

Name: Lauren Thelen Major: Health Care Administration The Art of Healing from the Inside-Out: A Memoir

Advisor’s Name: Anandita Mukherji, Ph.D. Reader’s Name: Melissa Bosworth, MS

The health care system is no stranger to many of us. From before we are born to our last days, we interact with health care settings and providers. This is a good thing--we receive care and feel better--or at least that is the case most of the time. What this statement does not acknowledge is that the health care system fails us, through inadequate communication, dialect barriers and inability to diagnose. The purpose …


Mentoring The Mentor: A Mentor Training Program, Sheri Gillis Jan 2024

Mentoring The Mentor: A Mentor Training Program, Sheri Gillis

Regis University Student Publications (comprehensive collection)

Mentorship has played an important role in nursing and nursing education for decades. However, there have yet to be any standard qualifications or training programs for those who mentor others. Poor mentorship increases faculty turnover, stress, and poor student outcomes. A quality improvement initiative was implemented in the Associate Degree Nursing Program using an evidence-based approach. Using a pre-post survey design with convenience sampling, five (N=5) nursing faculty met the qualifications to participate in the mentor training program. The Mentor Efficacy (MES) survey, which consisted of 30 questions, was administered to measure the participants' feelings of self-efficacy in the mentoring …


The Relationship Between Self-Reported Depressive Symptoms At 3 Timepoints And Infant Sleep Practices At 6-Month Follow-Up In A Population Of Mothers In Santo Domingo, Ecuador, Kassidy Lane Jan 2024

The Relationship Between Self-Reported Depressive Symptoms At 3 Timepoints And Infant Sleep Practices At 6-Month Follow-Up In A Population Of Mothers In Santo Domingo, Ecuador, Kassidy Lane

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract

Background

Previous studies have linked maternal depression with poor infant sleep (e.g., waking up at night and infants having trouble settling to sleep). This study examined the relationship between maternal depressive symptoms at three time points and safe infant sleep at 6-month follow-up.

Methods

Data was collected from a randomized clinical trial including 100 women recruited from a health center in Santo Domingo, Ecuador during their third trimester of pregnancy. Log-binomial regression was used to estimate prevalence ratios (PR) and 95% confidence intervals (CI) of safe infant sleeping at 6 months among mothers who reported depressive symptoms at 3 …


Program Evaluation Case Study, Grace Mullikin Jan 2024

Program Evaluation Case Study, Grace Mullikin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Program evaluation case study utilizing Center for Disease Control and Prevention's Case Evaluation Framework.


Changes In Primary Care Availability In Appalachia, Whitney Beckett Jan 2024

Changes In Primary Care Availability In Appalachia, Whitney Beckett

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Affordable Care Act (ACA) was a groundbreaking moment in the United States healthcare system. It affected many different aspects of the system, including access to primary care professionals. Primary care professionals provide a key role in American’s health, especially when it comes to preventative care. With one-third of Americans experiencing barriers to such access, a solution is desperately needed to increase said access. These barriers are especially profound in low-income, underserved areas such as the Appalachian regions of Georgia, Kentucky, Tennessee, and West Virginia. The ACA attempted to increase access via Medicaid expansion; however, not all States expanded their …