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Institutional Change In Healthcare As Brought About By The Critical Juncture Of The Covid-19 Pandemic, Olga Shvetsova

Working Papers Series

This introduction to the 2025 capstone symposium lays the conceptual groundwork for a new approach to analyzing institutional change in healthcare systems triggered by the COVID-19 pandemic. Departing from conventional legal-institutional perspectives, it extends the decision space framework developed by Bossert (1998) to capture both formal authority and the de-facto responsibilities exercised by public and non-public actors. By disaggregating health responsibilities across levels of government and sectors—public, private, and hybrid—and operationalizing these as quantifiable indicators over time, the framework allows for real-time and comparative assessment of institutional transformation. The pandemic is treated as a critical juncture that exposed and reconfigured …

Longitudinal Outcomes Of The Covid-19 Pandemic On Youth Physical Fitness, Andjelka Pavlovic, David Leonard, Timothy J Walker, Derek W Craig, Jizyah Injil, Laura F Defina

Faculty, Staff and Student Publications

Importance: The COVID-19 pandemic led to a decline in physical activity levels among youths, which could have a negative impact on their fitness.

Objective: To examine longitudinal changes in cardiorespiratory fitness (CRF) and musculoskeletal fitness (MSF) among students at schools participating in a school-based physical activity program during fall 2019 through spring 2023.

Design, setting, and participants: This longitudinal cohort study included US schools reporting CRF and MSF data at least once during the pandemic (fall 2020 to fall 2021) and at least 1 additional time before or after. In a subset of schools for which learning modality data was …

Covid-19 Pandemic And Recovery Experiences: A Case Study With Montana Family And Consumer Science Cooperative Extension Agents, Hayley M. Somerfeld, J. Mitchell Vaterlaus, Nicole C. Wanago, Brianna Routh, Alison Brennan

Journal of Human Sciences and Extension

The present study examined the impact of COVID-19 and recovery experiences among Family Consumer Science (FCS) Extension Agents in Montana. All participants (n = 10) completed a survey with fixed-item and open-ended responses, and six also participated in in-depth interviews. A deductive qualitative case study approach was used. Agent experiences were analyzed using The Sendai Framework for Disaster Risk Reduction (SFDRR) four action priorities: (1) understanding risk, (2) strengthening disaster risk governance, (3) investing in disaster risk reduction for resilience, and (4) enhancing disaster preparedness for effective response and to “build back better” in recovery, rehabilitation, and reconstruction. Pandemic risks …

Factors Influencing Medical University Students' Emotions And Infection Prevention Behaviors Amid The Spread Of Covid-19: Analysis From A Social Network Perspective, Jian-Jhou Chen, Peih-Ying Lu

Journal of Medical Education

Background: By adopting a social network perspective, we estimated the impact of the extent of information dissemination and exchange on the emotions and behaviors of medical university students during the COVID-19 epidemic. Methods: Students from a medical university in southern Taiwan were selected through stratified sampling. From October 5 to October 11, 2020, a survey was conducted using a self-developed COVID-19 Response Assessment Scale. A total of 1,162 valid responses were collected. Results: Higher frequencies of information acquisition from social networks or news media and information exchange with others in social networks were associated with higher levels of worries regarding …

Covid-19 And Gender Gap In Labor Market Recovery: Evidence From Nigeria, Marup Hossain

Economics Faculty Publications and Presentations

The COVID-19 pandemic-driven economic downturn can have substantial implications for the gender gap in the labor market in developing countries, where women are already worse off in job participation and earnings than men. After more than two years of the pandemic, how has the labor market reshaped in developing countries like Nigeria? Using multiple rounds of data before and after the pandemic and incorporating a difference-in-differences design, we show that overall employment dropped in the post-epidemic period in Nigeria. Importantly, overall employment fell more for women than men in Nigeria. Women in the high-COVID-intensity areas also experienced a larger shift …

Covid-19 Pandemic Impacts On Behavioral And Emotional Health Of Young Children With Autism., Olivia M. Pokoski, Hayley M. Crain, Sarah M. Furnier, Ronald E. Gangnon, Cy Nadler, Eric J. Moody, Karen Pazol, Maria A. Stanley, Lisa D. Wiggins, Maureen S. Durkin

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To test initial hypotheses that the coronavirus disease 2019 (COVID-19) pandemic was associated with decreases in adaptive behavior and increases in behavioral and emotional problems of children with autism; greater impacts for children who lost specialty services; and greater behavioral and emotional problems for children with autism vs control participants.

METHOD: Eligible participants (N = 1,158) enrolled in phase 3 of the multisite, case-control Study to Explore Early Development (SEED) before March 31, 2020, were between 2 and 5 years old, and completed follow-up assessments between January and July 2021. Caregivers completed a COVID-19 Impact Assessment Questionnaire, Vineland Adaptive …

The Burden Of Burnout: Understanding Its Prevalence And Organizational Drivers In Medical Physics, Deborah Schofield, C Lynn Chevalier, Laurence Court, William Harmsen, Akiva Turner

Faculty, Staff and Student Publications

Background: Burnout is a work-related syndrome characterized by increased levels of emotional exhaustion (EE) and depersonalization (DP) along with decreased levels of personal achievement. In the healthcare setting, higher burnout levels have been associated with negative impacts on personnel, an increased risk of errors, and a decrease in the quality of delivered care.

Purpose: The purpose of this study was to assess the prevalence of burnout among medical physicists working in the United States. Additionally, the impact of personal and organizational features on burnout risk was examined.

Methods: The anonymous survey was distributed to 1962 full members of the American …

The Gender Effects Of Covid: Evidence From Equity Analysts, Frank Weikai Li, Baolian Wang

Research Collection Lee Kong Chian School Of Business

We use COVID-19 and sell-side analysts as an experiment to study the effects of gender on labor productivity. We find that the forecast accuracy of female analysts declined more than that of male analysts, especially when schools were closed and among analysts who were more likely to have young children, were inexperienced, were busier, or lived in southern states of the US. Relative to male analysts, females also reduced their forecast timeliness and resorted to more heuristic forecasts but did not reduce coverage or updating frequency. Relative to pre pandemic, female analysts’ careers were more negatively affected than male analysts’. …

A Virtual Wellness Program To Enhance Well-Being For Pediatric Oncology Staff During The Covid-19 Pandemic, Karen M Moody, Maria Chang Swartz, Zachary Gresham, Martha Askins, Laura Cahalan, Christine Geistkemper, Amy Heaton, Ruitao Lin, Melissa Melo, Alakh Rajan, Madeline Smith, Priti Tewari, Keyana Williams, Cheng-Han Yang, Rhonda Robert

Faculty, Staff and Student Publications

In response to the COVID-19 global health crisis and mandated social isolation, Pediatric leadership at MD Anderson Children's Cancer Hospital was concerned for the psychological impact on its workforce and encouraged wellness programming. A grassroots wellness taskforce was assembled for the Division of Pediatrics. The task force's primary mission was to promote the well-being of clinicians and non-clinical staff members through a broadly accessible, sustainable, and effective virtual wellness program. Guided by the Stanford Model for Professional Fulfillment, a virtual program entitled, "Weekly Wellness Webex" for Pediatrics staff was launched. Weekly Wellness Webex is a 1-hour live-streamed program with varied …

Alterations In Gut Microbiome Composition And Increased Inflammatory Markers In Post-Covid-19 Individuals, Tatiana Barichello, Bruno Kluwe-Schiavon, Laura A Borba, Lucas C Pedro, Flávia S Niero, Laísa N Dos Santos, Letícia M Leonardo, Zuleide M Ignácio, Rodrigo Morales, Luciane B Ceretta, Gislaine Z Reus

Faculty, Staff and Student Publications

Dysfunctions in the immune system and alterations in the microbiome composition following SARS-CoV-2 infection contribute to persistent neurological issues observed in long COVID-19 survivors. We hypothesize that alterations in the gut microbiome composition and peripheral inflammatory profile following COVID-19 may play pivotal roles in behavior changes among individuals experiencing long-term illness. This cross-sectional study included a sample of post-COVID-19 and non-COVID-19 subjects. We assessed the presence of psychiatric conditions utilizing standardized diagnostic criteria, Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HAM-D), Biological Rhythms in Neuropsychiatry Assessment Interview (BRIAN), and Functional Assessment Short Test (FAST). Plasma samples …

Predictors Of Nursing Students' Stress, Anxiety, And Depression During The Covid-19 Pandemic In A Hispanic-Serving University In South Texas: A Cross-Sectional Study, Maria I. Diaz, Eleftherios Gkioulekas, Nancy Nadeau

School of Mathematical & Statistical Sciences Faculty Publications

Background: In nursing education, there have been several studies on the impact of the COVID-19 pandemic on the ability of nursing students to cope while in nursing school.

Purpose statement: The goal of this study is to assess undergraduate nursing students' support mechanisms as predictors of stress, anxiety, and depression during the COVID-19 pandemic within a Hispanic-serving institution in South Texas.

Methods: Across-sectional design was used in this study. An online survey using self-reported questionnaires was used to gather data from an undergraduate nursing student cohort during the Fall 2021 semester. Linear regression was used to identify the predictors of …

Association Of Sars-Cov-2 With Health-Related Quality Of Life 1 Year After Illness Using Latent Transition Analysis, Lauren Wisk, Michael Gottlieb, Peizheng Chen, Huihui Yu, Kelli O'Laughlin, Kari Stephens, Graham Nichol, Juan Carlos Montoy, Robert Rodriguez, Michelle Santangelo, Kristyn Gatling, Erica Spatz, Arjun Venkatesh, Kristin Rising, Mandy Hill, Ryan Huebinger, Ahamed Idris, Michael Willis, Efrat Kean, Samuel Mcdonald, Joann Elmore, Robert Weinstein

Department of Emergency Medicine Faculty Papers

BACKGROUND: Long-term sequelae after SARS-CoV-2 infection may impact health-related quality-of-life (HRQoL), yet it is unknown how HRQoL changes during recovery. We compared patient-reported HRQoL among adults with COVID-19-like illness who tested SARS-CoV-2 positive (COVID+) with those who tested negative (COVID-).

METHODS: Participants in this prospective, multicenter, longitudinal registry study were enrolled from December 2020 through August 2022 and completed 3-month follow-up assessments until 12 months after enrollment. Participants were adults (≥18 years) with acute symptoms suggestive of COVID-19 who received a Food and Drug Administration-approved SARS-CoV-2 test. Participants received questions from PROMIS-29 (subscales: physical function, anxiety, depression, fatigue, social participation, …

Anticommandeering Climate Action: Defending The Necessity Of Subfederal Planet-Saving Legislation, Tyler Hall

San Diego Journal of Climate & Energy Law

Humanity is on the defensive against climate change, and state and local governments are the front line. Regrettably, Americans have waited too long for air cover in the form of federal climate regulations despite an established history of federal environmental action only emerging from the ashes of headline-grabbing catastrophes. Americans cannot wait on federal legislation to tackle the global and unprecedented problem of climate change. It will come far too late.

State and local governments’ historic police power includes protecting environmental health and public welfare, but decades of successful federal regulation have atrophied its use. Delayed by federal success, state …

Gratitude, Growth & Giving Back: Closing My Chapter As Mdds President, Susan Kutis Dds

Metro Denver Dental Society Articulator Magazine

As the MDDS President, Dr. Susan Kutis, concludes her term, she reflects on how the COVID-19 pandemic renewed her commitment to organized dentistry. From addressing workforce challenges and student debt to fostering mentorship and professional growth, the article highlights the importance of volunteer leadership and the enduring value of community within MDDS.

Wildlife Road Mortalities During Covid-19 Pandemic-Related Lockdown In South Texas: A Comparative Survey, Bradley Evan Beer, Kevin W. Ryer, Md Saydur Rahman, John H. Young Jr., Richard J. Kline

School of Earth, Environmental, & Marine Sciences Faculty Publications

Mortalities of wildlife caused by collisions with vehicles along roads are increasing in prevalence, threatening the existence of various species and populations. The COVID-19 pandemic-related lockdown provided an opportunity to gain a better understanding of how wildlife vehicle mortality occurrences change in response to anthropogenic variables and how varying survey methods influence obtaining mortality data. In this study, data were collected in three observation periods: pre-lockdown (PreL), during lockdown (DL), and post-lockdown (PostL) in south Texas. There were 194 wildlife mortalities recorded during weeks 4–27 of 2020. Results of this study showed that road mortality survey counts did not change …

Hand Hygiene Roles, Challenges, And Intervention Feedback From School Staff: A Qualitative Analysis, Belize, 2022-2023, Anh N Ly, Christina Craig, Dian Maheia, Yolanda Gongora, Vickie Romero, Rosalva Blanco, Allison Lino, Kelsey Mcdavid, Allison Stewart, Victoria Trinies, Alexandra Medley, Francis Morey, Russell Manzanero, Matthew Lozier, Kristy O Murray

Faculty, Staff and Students Publications

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff's experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge …

Seeing Resilience Through Experience: Teachers' Resilience Experiences Post Covid-19 Pandemic, Yashica Dudley

Doctoral Dissertations and Projects

The purpose of this phenomenological was to describe the post-COVID-19 resilience experiences of 6th to 12th grade schoolteachers at Hope County Public School (HCPS). The theory that guided this study is the differing pathways to resiliency theory, as it was used to describe teachers’ resilience experiences regarding the outlook on work, self-efficacy, and coping responses. The central research question was, “What are the post-COVID-19 resilience experiences of 6th to 12th grade schoolteachers at the HCPS in the classroom?” Participants included 10-15 6th to 12th grade schoolteachers who taught before, during, and post the COVID-19 pandemic. The data was collected through …

Exploring The Challenges And Resilience Of Licensed Black Female Counselors In Texas During The Covid-19 Pandemic And George Floyd Era: A Phenomenological Study, Krissandra C. Haynes

Doctoral Dissertations and Projects

The purpose of this transcendental phenomenological study was to describe the licensed Black female counselors (LBFCs) that provided mental health services during the COVID-19 pandemic and George Floyd era. This study was guided by Schlossberg’s transition theory to examine how LBFCs navigated professional and personal transitions during a time marked by collective trauma, public health disparities, and heightened racial tension. Participants described this time of counseling clients through parallel experiences of grief and social unrest while also tending to their wellness. Core themes included the duality of the healer role, significance of spiritual and faith-based coping, influence of social activism, …

Effects Of Covid-19 On Special Education Teachers In Calvert County, Maryland, Jody L. Scott

Doctoral Dissertations and Projects

The purpose of this phenomenological research was to understand and describe the lived experiences and impact of the COVID-19 global pandemic and the subsequent traumas on Special Education teachers in Calvert County, Maryland. It is rooted in axiological assumptions and guided by social constructivism and transition theory. Transition theory, as posited by Nancy K. Schlossberg, relates to the cycle of change in each educator using the “Four Ss” in the transition process: Self, Situation, Support, and Strategies. Special Education teachers took part in a Conceptual Mapping Task to express lived experiences during and after the pandemic. The activity aided each …

Teacher Perspective And De-Escalation Of Aggressive And Disruptive Behaviors In Early Elementary Students Who Come To School At Risk Of Academic Failure: A Phenomenological Study, Rebecca L. Thurman

Doctoral Dissertations and Projects

The purpose of this qualitative, hermeneutic phenomenological research study was to understand the experiences of early elementary educators with the rising negative behaviors, such as aggression and classroom disruptions, in their current classrooms within a progressive and growing school district in northwest Georgia. The theory that guided this study was Bandura’s social learning theory. This study addressed the question: How do educators perceive, understand possible causes, and utilize research-based programs and strategies to de-escalate and improve students’ aggressive and disruptive behaviors in the elementary classroom? This study focused on individual and focus group interviews, as well as a teacher behavior …

Impact Of Nursing Home Staff Hours And Administrator Turnover On Quality Of Care Post-Covid-19 Pandemic In Texas, Kendra King

Walden Dissertations and Doctoral Studies

Nursing facilities experienced heightened unfavorable outcomes related to quality of care and staffing patterns during the COVID-19 pandemic. The purpose of this quantitative, quasi-experimental, retrospective study was to determine if there was a relationship between nursing home administrator turnover, total nurse staffing (i.e., LPN, RN, and nurse aides) hours per resident per day, and the quality of care as measured by the Long Stay Quality Measure (LSQM) rating in Texas after the COVID-19 pandemic in 2023. The Donabedian model, using the elements of structure, process, and outcomes, served as the theoretical framework for this study. Structure was represented by the …

Turning Analysis Into Action: Opportunities And Challenges In Implementing Wastewater Science For Public Health Decision-Making, Anna Gitter, Valeria Ruvalcaba, Katelyn Clark, Theresa Tran Carapucci, Fuqing Wu, Blake M Hanson, Jennifer Deegan, John Balliew, Eric Boerwinkle, Anthony W Maresso, Kristina D Mena

Faculty, Staff and Students Publications

In the 5 years since the emergence of the COVID-19 pandemic, the field of wastewater-based epidemiology (WBE) has dramatically expanded with programs implemented across the globe to monitor for SARS-CoV-2 and other viruses of public health concern. However, the best way to use wastewater surveillance data and inform local communities of the utility of wastewater science remains limited and sporadically discussed. Specifically, there is vague guidance regarding interpreting varying levels of viral loads in wastewater for public health significance. While collaborative efforts are key to implementing these community-specific wastewater surveillance programs, effectively using the data for public health decision-making still …

Leading Through Crisis: San Diego County Schools' Response To The Social Emotional Needs Of All Students, Johana Bielma

Dissertations

The COVID-19 pandemic led to unprecedented school closures, forcing administrators to take decisive action to radically change the educational system. The imperative to switch to remote learning transformed the dynamics of teaching and learning, leading to both immediate and long-term academic and social emotional consequences for all stakeholders. When schools reopened, administrators faced the challenge of reintegrating students into in-person learning while addressing the pandemic’s lasting effects on academics, mental health, and school safety. While academic regression was evident, the extent of students’ emotional struggles was less anticipated. Many students exhibited increased irritability and mental health issues such as depression …

Shifting To A Culture Of Inclusion By Design: Applying A Mixed-Methods Approach To Advance Accessibility Of Public Health Emergency Information & Communication Technology, Jessica L. Franks, Erin Vinoski Thomas

Developmental Disabilities Network Journal

Adults with intellectual and developmental disabilities (IDD) experience inequities in access to timely, accurate, and understandable information and communication technology (ICT), which increases risk for public health emergency (PHE)-related health disparities and impedes opportunities to achieve optimal health. This study assessed federal COVID-19 webpage accessibility levels and explored existing knowledge of and experience with filing accessibility complaints for federal ICT among adults with IDD. Through a mixed-methods approach, we evaluated compliance with accessibility standards for 18 federal agencies’ COVID-19 webpages (study 1) and interviewed 16 adults with IDD about experiences accessing federal webpages and filing accessibility complaints (study 2). We …

Science Tikkun: A Bioscience Pandemic Framework In A Hebrew Tradition Of Global Repair, Peter Hotez

Center for Medical Ethics and Health Policy Staff Publications

Over the past decade we have seen a steady increase in dangerous pandemic threats. They include two major Ebola epidemics and cholera in Africa; dengue, Zika, yellow fever in the Americas; a COVID-19 pandemic; and H5N1 in Texas. This is happening because of a confluence of modern forces including urbanization, deforestation, and climate change. Yet as pandemics emerge on a crowded and warming planet, anti-science disinformation and antisemitism impede our response. Science tikkun is an overarching framework for repair and redress. It honors the legacy of Maimonides, Teilhard de Chardin, and others who have sought reconciliation between science and religion.

Voices Of Leadership: The Perceptions And Lived Experiences Of Principals Amid The Covid-19 Pandemic, Jeri Johnson

Graduate Theses & Dissertations

The COVID-19 pandemic created a crisis in schools. The purpose of this research is to explore the phenomenon and lived experiences of principals as they led their schools during COVID-19. This qualitative research will explore how principals navigated the complexity of leadership to sustain academic achievement. Principals will share how the three levels of crisis, danger and opportunity created a pathway for principal actions of effectiveness. Additionally, this research explored how principals made sense of the crisis to promote community, collaboration and compassion. Principals were asked to describe their perceptions of leadership and to share their lived experiences from March …

Exploring The Public Health Agency Of Canada’S And The Ontario Government’S Vaccine-Related Crisis Communication On X During The Covid-19 Pandemic, Sheraza Burney, Lori Donelle Phd, Rn, Fcan, Anita Kothari

Publications

Crisis communication strategies must be tailored to the unique nature of social media. In response to the COVID-19 pandemic, public health agencies have widely used social media to address vaccine hesitancy and misinformation. This research utilized the social media pandemic communication model to describe the key themes disseminated through the Ontario government and the Public Health Agency of Canada's vaccine-related crisis communication on X (formerly Twitter). Between 27 January 2020 and 6 April 2021, 1271 posts related to COVID-19 vaccination were collected from three official government X accounts—two from the province of Ontario and one from Canada. Posts were analyzed …

The Moderating Effect Of Political Ideology On The Relationship Between Locus Of Control And Covid-19-Related Anxiety And Stress, Sarah Boomhower

Walden Dissertations and Doctoral Studies

The COVID-19 pandemic created a mental health crisis within the United States. Previous research examining locus of control and mental health issues during the pandemic revealed that individuals with an external locus of control exhibited increased mental health symptoms. Research also found that political attitudes played a role regarding COVID-19 with liberal-leaning individuals and Democrats reporting higher levels of emotional distress during the pandemic. The purpose of this quantitative, nonexperimental, correlational study was to determine the extent to which political ideology moderates the relationship between locus of control and COVID-19-related anxiety and stress. Locus of control was the theoretical foundation …

Covid-19 And Related Adverse Neurological Complications, Hannah A. Wasson

Honors Thesis

Abstract

The COVID-19 pandemic changed the world drastically, and its impact was monumental. COVID-19 or SARS-CoV-2, or severe acute respiratory syndrome, was the virus responsible for causing such mayhem. This contagious virus can enter the body via different routes, live on surfaces for hours, and be transmitted through the air, increasing infection risk. Once it enters the body, it can trick the body into replicating the virus. From this reaction within the body, signs and symptoms follow. While the name indicates a respiratory illness, the virus can inflict injury on other parts of the body. Due to the organ systems …

A Virtual Wellness Program To Enhance Well-Being For Pediatric Oncology Staff During The Covid-19 Pandemic, Karen Moody, Maria Swartz, Zachary Gresham, Martha Askins, Laura Cahalan, Pavilia Francis, Christine Geistkemper, Amy Heaton, Ruitao Lin, Melissa Melo, Alakh Rajan, Madeline Smith, Priti Tewari, Keyana R. Williams, Cheng-Han Yang, Rhonda Robert

Advances in Cancer Education and Quality Improvement

In response to the COVID-19 global health crisis and mandated social isolation, Pediatric leadership at MD Anderson Children’s Cancer Hospital was concerned for the psychological impact on its workforce and encouraged wellness programming. A grassroots wellness taskforce was assembled for the Division of Pediatrics. The task force’s primary mission was to promote the well-being of clinicians and non-clinical staff members through a broadly accessible, sustainable, and effective virtual wellness program. Guided by the Stanford Model for Professional Fulfillment, a virtual program entitled, “Weekly Wellness Webex” for Pediatrics staff was launched. Weekly Wellness Webex is a 1-hour live-streamed program with varied …