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An Examination Of Clinical Pain Severity, Sleep Quality, And Neighborhood Disadvantage In A Racially/Ethically Diverse Sample Of Adults With Symptomatic Knee Osteoarthritis, Cesar Emmanuel Gonzalez Jan 2023

An Examination Of Clinical Pain Severity, Sleep Quality, And Neighborhood Disadvantage In A Racially/Ethically Diverse Sample Of Adults With Symptomatic Knee Osteoarthritis, Cesar Emmanuel Gonzalez

All ETDs from UAB

Knee osteoarthritis (OA) is often accompanied by insomnia symptoms, character-ized by difficulty falling asleep, maintaining sleep, or both. Among individuals with knee OA, up to 31% report significant difficulty falling asleep, 81% have difficulties staying asleep, and up to 77% report any sleep problem. However, the sleep and pain relationship has also rarely been evaluated using objective and subjective sleep measures. Thus, this study attempted to characterize objective and subjective sleep variables in a diverse sam-ple of individuals with symptomatic knee OA. Further, the impact of objective and sub-jective sleep quality on clinical pain severity, movement-evoked pain, and physical func-tion …

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International Graduate Students In A Master Of Public Health Program: A Mixed Methods Study To Identify Challenges And Needed Supports, Melinda S. Harrison Jan 2023

International Graduate Students In A Master Of Public Health Program: A Mixed Methods Study To Identify Challenges And Needed Supports, Melinda S. Harrison

All ETDs from UAB

The increase in international graduate students (IGSs) in the United States in recent years has created additional linguistic and cultural diversity in graduate programs, thus, spotlighting the existence of these students’ unmet challenges. Although much research has been conducted on the experiences of international students in U.S. higher education contexts, very little research has focused on IGSs’ transition experiences to and through academic and professional university programs by way of pathway language support programs. Applying activity theory, I designed and conducted this case study with explanatory sequential mixed methods to investigate IGSs’ experiences as they transitioned into and through a …

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Aging With Hiv And Comorbid Chronic Obstructive Pulmonary Disease, Jun Yeong Byun Jan 2023

Aging With Hiv And Comorbid Chronic Obstructive Pulmonary Disease, Jun Yeong Byun

All ETDs from UAB

Older adults with human immunodeficiency virus (HIV) experience a high prevalence of chronic obstructive pulmonary disease (COPD). Considering having either HIV or COPD is related to worse health outcomes in older adults, aging with both HIV and COPD may synergistically and negatively affect the health outcomes of older people with HIV (PWH) and comorbid COPD. The purpose of this dissertation was to explore the aging of PWH with COPD. This purpose was accomplished through three articles: 1) an adaptation of a gerontological model investigating what is known about the aging of PWH and people with COPD and extrapolating that to …

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Effects Of Mindfulness-Based Intervention On Mental Health Outcomes In Youth Who Are Underserved, Melanie Grace Albright Jan 2023

Effects Of Mindfulness-Based Intervention On Mental Health Outcomes In Youth Who Are Underserved, Melanie Grace Albright

All ETDs from UAB

olescence, a period of rapid brain maturation and development coincides with the development of mental health disorders. Many teens in the United States with diagnosable mental health conditions lack mental health treatment due to limited access and provider availability, particularly affecting adolescents who are underserved. School-based interventions, including those centered around mindfulness-based stress reduction (MBSR) have shown promise in their effectiveness among adolescents. This study examines the impact of an in-school MBSR-based program, MindUP, on mental health outcomes, including depressive symptomology, anxiety symptomology, and perceived stress, in adolescents who are underserved. Additionally, focus group discussions were conducted with students participating …

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Taking Corrigibility Seriously, Dora Klein Jan 2023

Taking Corrigibility Seriously, Dora Klein

Faculty Articles

This article argues that the Supreme Court's creation of a category of "irreparably corrupt" juveniles is not only an epistemological mistake but also a tactical mistake which has undermined the Court's express desire that only in the "rarest" of cases will juveniles be sentenced to life in prison without the possibility of parole.

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Medical Emergency Preparedness Among Undergraduate Students, Savannah L. Finigan Jan 2023

Medical Emergency Preparedness Among Undergraduate Students, Savannah L. Finigan

Honors Theses

Knowing how to respond to a medical emergency is a valuable life skill that college students ought to have the opportunity to attain in order to save lives. This study aims to understand how prepared and confident local students are to respond to a medical emergency. Participants consisted of undergraduate students who had no healthcare or nursing school experience. A survey was distributed that asked students to rank and describe their own confidence to respond to medical emergencies. The survey also questioned how much former training or experience they had with medical emergencies. The results of the survey show that …

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Rates, Presentation, & Effects Of Public Autism Stigma, Monica Abdul-Chani Jan 2023

Rates, Presentation, & Effects Of Public Autism Stigma, Monica Abdul-Chani

All ETDs from UAB

Limited availability of resources regarding developmental issues, health literacy, linguistic-sensitivity (i.e., use of linguistically appropriate resources and measures), structural barriers (i.e., appointment length, transportation), and cultural values and beliefs are commonly-cited barriers in identifying Latine autistic children. Stigma may also play a role, as it is negatively related to both knowledge/awareness within ASD and to acculturation in other disorders (i.e., HIV). Stigma can have detrimental, pervasive effects on daily living for those stigmatized and their families. Limited research examined the rate, presentation, and effect of ASD stigma within the Latine community, and all available studies explored stigma as reported by …

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An Exploration Of The Values Elicitation Experiences Of Patients With Heart Failure And Their Family Caregivers, Avery Bechthold Jan 2023

An Exploration Of The Values Elicitation Experiences Of Patients With Heart Failure And Their Family Caregivers, Avery Bechthold

All ETDs from UAB

Values, defined as abstract, subjective, and significant core beliefs, which function within a system and priority, are integral to how individuals make decisions, and cope with stressors, including serious illness. However, little research has been conducted to explore the experiences of patients with heart failure (HF) and their family caregivers. Therefore, the purpose of this dissertation was to explore how values are discussed, reflected upon, and acted on by patients with HF and their family caregivers. This purpose was accomplished through four manuscripts and a mixed methods analysis: 1) a concept analysis of values elicitation in the context of health …

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I Would Be Shocked If Someone’S Not Depressed With That Diagnosis”: An In-Depth Exploration Of The Manifestation And Management Of Depression And Anxiety In Patients With Cancer, Carmen Rainey Brown Jan 2023

I Would Be Shocked If Someone’S Not Depressed With That Diagnosis”: An In-Depth Exploration Of The Manifestation And Management Of Depression And Anxiety In Patients With Cancer, Carmen Rainey Brown

All ETDs from UAB

Patients diagnosed with cancer experience depression and anxiety at higher rates compared to the general population. Most individuals diagnosed with cancer will experience symptoms of depression and anxiety at some point during their cancer trajectory and not seek care leaving their mental health conditions undiagnosed and untreated, which impact quality of life and cancer outcomes. Patient and providers perspectives are vital to understand the manifestation, care-seeking behaviors, and provider management of depression and anxiety in patients with cancer. This study sought to explore the manifestation of depression and anxiety among patients with cancer and their care seeking behaviors for mental …

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Towards Minimally Invasive Genetically Targeted Control Of Neural Activity Using X-Rays, Kelli Cannon Jan 2023

Towards Minimally Invasive Genetically Targeted Control Of Neural Activity Using X-Rays, Kelli Cannon

All ETDs from UAB

X-genetics aims to replace visible light stimulation in optogenetics with X-radiation, offering improved bone penetration, minimal scattering, and enhanced targeting capabilities. This eliminates the need for surgical optic fiber implantation, reducing invasiveness and minimizing off-target effects. Discovering a receptor protein sensitive to X-rays or their byproducts is pivotal for advancing X-genetics.Two genetically encoded X-ray receptors (GEXRs) were investigated for X-genetics application: rhodopsin, historically associated with X-ray responses, and LITE-1, an unexpected candidate. Rhodopsin, when expressed in human embryonic kidney (HEK293) cells, demonstrated robust cAMP decreases upon visible light stimulation but remained unresponsive to moderate and high-dose X-rays, suggesting it may …

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Weight Loss And Physical Activity For People With Physical Disabilities, Julianne Clina Jan 2023

Weight Loss And Physical Activity For People With Physical Disabilities, Julianne Clina

All ETDs from UAB

People with physical disabilities (PWD) are at higher risk of obesity than people with-out physical disability (PWoD). For PWD, obesity presents a greater risk of secondary conditions; preventable medical, emotional, or social problems resulting directly or in-directly from an initial disabling condition. There is incomplete information about how disability-specific concerns influence obesity treatment and weight management, in part because PWD have typically not been included in this research. Additionally, while studies exist examining weight loss in PWD, a dearth of research exists examining weight loss maintenance for this population. Previously, weight control registries have been a valuable tool in gaining …

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Conceptual Architecture For Digital Twin Implementation In A Smart City Framework, Wesley Conwell Jan 2023

Conceptual Architecture For Digital Twin Implementation In A Smart City Framework, Wesley Conwell

All ETDs from UAB

More than 9 billion people are expected to live on the planet in 2050, about two-thirds in cities. This substantial population growth in urban areas increases demands on cities' resources, services, and infrastructure. Hence, many cities leverage intelligent technologies to ensure urban communities' efficiency in integrating massive infrastructure components and services. Cities define this reconstruction of their operational framework as a smart city. Effective resource consumption management in a smart city integrative structure presents a problem with solutions concerning the distribution of city services. This dissertation aims to establish a conceptual framework to effectively manage resource consumption in a smart …

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Enhancing Racial Identity And Promoting Academic Enablers In Black Adolescent Males Through Film Viewing, Carlos Napoleon Espinoza Jan 2023

Enhancing Racial Identity And Promoting Academic Enablers In Black Adolescent Males Through Film Viewing, Carlos Napoleon Espinoza

All ETDs from UAB

Among Black adolescent males, classroom discrimination is associated with lower academic performance, academic self-concept, and value placed on education. Although efforts aimed at eliminating racism and discrimination should be made, it is important to identify interventions that may mitigate the effects of discrimination on academic outcomes of Black adolescent males. Previously identified protective factors include positive racial socialization, positive racial identity, and Black role models. Thus, this project attempted to integrate these protective factors into a unified intervention approach in which Black role models deliver positive racial socialization messages to enhance positive racial identity and academic enablers through films. Preexisting …

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Transdiagnostic Symptom Clusters Among Idiopathic Pain And Fatigue Disorders, Chloe Lisette Jones Jan 2023

Transdiagnostic Symptom Clusters Among Idiopathic Pain And Fatigue Disorders, Chloe Lisette Jones

All ETDs from UAB

Background: There are no established etiologies, biomarkers, or approved treatments for myalgicencephalomyelitis/chronic fatigue syndrome (ME/CFS). It is thought that the ME/CFS criteria may be diagnosing individuals within a spectrum of different disease states, or even different diseases. There likely exist shared mechanisms across idiopathic pain and fatigue disorders, and diverse mechanisms underneath each individual diagnosis. The need to compare ME/CFS to similar, overlapping, and distinct disorders is a critical element in progressing our understanding of idiopathic pain and fatigue. Methods: A total of 2,731 comprehensive medical history and symptom reports were collected from respondents across the globe with a variety …

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Unintended Pregnancy, Postpartum Contraception, And Healthcare Utilization Among Young Married Women Affected By Hiv In Kenya, Liza M. Kimbo Jan 2023

Unintended Pregnancy, Postpartum Contraception, And Healthcare Utilization Among Young Married Women Affected By Hiv In Kenya, Liza M. Kimbo

All ETDs from UAB

Women with an unintended pregnancy are at risk of a repeat unintended pregnancy. Although use of postpartum contraception is an effective way to prevent repeat unintended pregnancies, the majority of unintended pregnancies globally occur in women who are not using contraception. Unintended pregnancies can have negative health and social consequences for both women and their children. This study aimed to better understand the use of postpartum contraceptives and healthcare services by married women with unintended versus intended pregnancy in south-western Kenya, with a special focus on young women. The study followed an exploratory sequential mixed methods design. In the first …

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Examining The Impact Of The Covid-19 Pandemic And Subsequent Vaccine Availability On Children’S Social Play Opportunities With A Focus On The Autism Community, Jenni Koehler Jan 2023

Examining The Impact Of The Covid-19 Pandemic And Subsequent Vaccine Availability On Children’S Social Play Opportunities With A Focus On The Autism Community, Jenni Koehler

All ETDs from UAB

Play, especially social play, is crucial to child development and impacts their cognitive, socioemotional, and motor growth. Children with an autism spectrum disorder (ASD) have social and motor impairments that act as barriers to their access to these critical social play opportunities. Those who are able to overcome these barriers through therapy have been shown to have better physical and mental outcomes. Unfortunately, the COVID-19 pandemic restricted social play opportunities for all children and disproportionately impacted children with ASD, further widening developmental gaps between them and their non-autistic peers. The development of the COVID-19 vaccine and its availability to children …

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Resilience And Vulnerability: The Impact Of Deprivation, Social Capital, And Distance Sensitivity On Mental Health In Covid-19 Vaccine Seekers, Cesar Ivan Landeros Jan 2023

Resilience And Vulnerability: The Impact Of Deprivation, Social Capital, And Distance Sensitivity On Mental Health In Covid-19 Vaccine Seekers, Cesar Ivan Landeros

All ETDs from UAB

The COVID-19 pandemic has inflicted profound challenges upon California, exacerbating disparities in care, access, and health outcomes within vulnerable and deprived communities. Especially, this crisis has led to a surge in mental health issues, with anxiety and depression emerging as predominant psychopathologies, and the rates of anxiety and depression are alarmingly high in disadvantaged communities. In California, the strikingly high prevalence of these symptoms at 31.7%, compared to the national average of 32.3%, sounds a critical alarm. Despite empirical investigations into anxiety and depression rates across a range of demographic groups worldwide—such as survivors, healthcare professionals, children, adolescents, and adults—the …

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Parenting Through A Pandemic: A Mixed Methods Analysis Of Covid-19’S Impact On Stress, Coping, Resiliency, And Mental Health Among University Student-Parents, Jordin Ann Lane Jan 2023

Parenting Through A Pandemic: A Mixed Methods Analysis Of Covid-19’S Impact On Stress, Coping, Resiliency, And Mental Health Among University Student-Parents, Jordin Ann Lane

All ETDs from UAB

The COVID-19 pandemic has taken a toll on the mental health of university students and continues to have a profound impact to this day. The transition from in-person traditional courses to online courses and campus closures, coupled with feelings of isolation, fear of contracting COVID-19, and uncertainty of the future has further intensified the mental health of college students. The effects of federal and state regulations, such as stay-at-home orders, influenced the mental health and general well-being of many Americans, specifically those who take on a dual role as a student and a parent. Unfortunately, literature pertaining to the effects …

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Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel Jan 2023

Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel

All ETDs from UAB

Introduction: HIV (Human Immunodeficiency Virus) is a sexually transmitted infection (STI) that is still a major health issue in the United States and the world. Emerging adults are more likely to engage in risky sexual behaviors such as multiple sexual partners and unprotected sex. HIV testing contributes to ending the HIV epidemic by identifying at-risk individuals and promoting early diagnosis.Methods: Secondary data analyses of the City Health II dataset were conducted to 1) identify the association between HIV testing and risky sexual behaviors among Black/African American emerging adults ages 18-25 years living in Birmingham metro area, 2) use social network …

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The Influence Of Proximity On Patient Outcomes For Differently Structured Ambulatory Surgery Centers, Wendy Michelle Smith Jan 2023

The Influence Of Proximity On Patient Outcomes For Differently Structured Ambulatory Surgery Centers, Wendy Michelle Smith

All ETDs from UAB

THE INFLUENCE OF PROXIMITY ON PATIENT OUTCOMES FOR DIFFERENTLY STRUCTURED AMBULATORY SURGERY CENTERSWENDY SMITH HEALTH SERVICES ADMINISTRATION ABSTRACT This study examines the complication rates and patient-reported outcome measures (PROMs) for total hip and knee replacement surgeries conducted in one of two differently structured ambulatory surgical centers (ASCs) with varying interprofessional surgical teams. There is an ongoing shift from in-hospital total joint replacement surgeries to ASCs. Additionally, there is specialization occurring within ASCs. In this study, we compare single specialty ASCs designed to perform solely TJR surgeries with one orthopedic group and interprofessional team, with multi-specialty ASCs that perform an array …

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Neuropeptide Y Overexpression In The Presence Of P23h Rhodopsin Mutation, Jean Sun Jan 2023

Neuropeptide Y Overexpression In The Presence Of P23h Rhodopsin Mutation, Jean Sun

All ETDs from UAB

Neuropeptide Y (NPY), a 36-amino acid peptide, has been found to be the most abundant neuropeptide in the central nervous system, and it is widespread across mammalian species. NPY plays a dual role as a neurotransmitter and neuromodulator in the nervous system. NPY functions as a multifaceted neuromodulator through binding NPY receptors (NPYRs). NYP interacts with NPYRs and regulates various activities, such as cell growth, neurogenesis, neuroprotection, mitochondrial behaviors, food intake, anxiety, and addiction formation. In terms of NPY’s neuroprotective potential, NPY inhibits neuronal death signaling, thus preventing apoptosis, and displays anti-inflammatory and anti-oxidative effects. Additionally, it influences metabolism by …

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The Impact Of Diabetes On At-Fault Motor Vehicle Collisions In Older Adults: Visual Function, Medication, And Crash Characteristics, Thomas A. Swain Jan 2023

The Impact Of Diabetes On At-Fault Motor Vehicle Collisions In Older Adults: Visual Function, Medication, And Crash Characteristics, Thomas A. Swain

All ETDs from UAB

Older drivers represent one of the fastest growing age groups of drivers in the United States. Crash risk among older adults, who have the highest prevalence of vision impairment, has been shown to be related to worse visual function. Diabetes mellitus is a chronic health condition affecting more than 23.1 million Americans, and one in three have pre-diabetes. Persons with diabetes are at increased risk of conditions which cause vision loss. Research indicates those with diabetes have higher rates of MVCs. Despite the increased MVC risk among each of these groups, work has yet to evaluate if diabetes modifies the …

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Senior Executive Experience And The Performance Of Healthcare Organizations, John Patrick Walsh Jan 2023

Senior Executive Experience And The Performance Of Healthcare Organizations, John Patrick Walsh

All ETDs from UAB

SENIOR EXECUTIVE EXPERIENCE AND THE PERFORMANCE OF HEALTHCARE ORGANIZATIONS JOHN P. WALSH HEALTH SERVICES ADMINISTRATION ABSTRACT The healthcare industry has become increasingly complex over the past two decades causing concern for stakeholders of hospitals and health systems regarding the future viability. Given the tumultuous times, understanding who is best suited to lead these organizations is essential. While some work has been done studying certain characteristics of the Senior Leaders of these organizations, none have looked at the relationship between the Senior Leader’s work experience comparing those with for-profit experience and those without and performance. Using Upper Echelon’s Theory as a …

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Impact Of Alcohol Intoxication On Pedestrian Risk-Taking Behaviors, Yixin Wang Jan 2023

Impact Of Alcohol Intoxication On Pedestrian Risk-Taking Behaviors, Yixin Wang

All ETDs from UAB

In the United States, motor vehicle crashes account for approximately 21.8% of unintentionaldeaths, and 17.2% of these crashes involved the death of a pedestrian in 2020. Two preventable factors that impact pedestrian fatalities are alcohol intoxication and smartphone distraction. Approximately 30% of fatal pedestrian crashes involve a pedestrian with a BAC of at least 0.08, and distraction is a commonly observed risk factor that was shown to impair crossing performance in virtual environments. The present research considers both distraction and intoxication as risk factors for pedestrian safety, examining both risk factors in isolation as well as their interactional effects on …

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A Qualitative Descriptive Study Exploring Infertility Help-Seeking Among African American Women, Andrea G. Wells Jan 2023

A Qualitative Descriptive Study Exploring Infertility Help-Seeking Among African American Women, Andrea G. Wells

All ETDs from UAB

BACKGROUND: Failure to achieve pregnancy (infertility) affects over 6 million women ages 15–44 in the United States. African American women have more difficulty getting pregnant than White women but are less likely to seek help for infertility. According to the current research, there are several factors (cost, insurance coverage, etc.) that create difficulty for women to seek help to get pregnant. However, little is known about the factors that influence or impede infertility help-seeking among African American women. The purpose of this study was to explore the barriers and facilitators to infertility help-seeking among African American women.METHODS: Factors affecting infertility …

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Neighborhood Disadvantage, Sleep Quality, And Shift Work: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Rebecca Williams Jan 2023

Neighborhood Disadvantage, Sleep Quality, And Shift Work: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Rebecca Williams

All ETDs from UAB

The first study used data (n=14,609) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) to test the associations among Area Deprivation Index (ADI) and self-reported total sleep time (TST), sleep efficiency (SE), and number of restless nights within the last week. The second study (n=12,496) tested the associations among ADI, shift work status, and restlessness.Regression models were fit to examine associations between ADI and SE or TST or restlessness, as well as assess the relation between ADI and SE in clinically meaningful categories. Moderation analyses indicated whether sex or race impact the association between ADI and sleep. …

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Cognition, Self-Awareness, And Driving After Moderate-To-Severe Traumatic Brain Injury, Christina A. Diblasio Jan 2023

Cognition, Self-Awareness, And Driving After Moderate-To-Severe Traumatic Brain Injury, Christina A. Diblasio

All ETDs from UAB

Moderate-to-severe traumatic brain injury (TBI) often results in cognitive deficits in learning/memory, executive functions, and self-awareness. Cognitive impairments and unawareness of those impairments hinder driving capacity, yet a large proportion of survivors return to driving after injury. Given that many survivors are driving, it is essential to understand how cognition and self-awareness impact driving practices. To date, studies in this area are limited. This dissertation aimed to (1) create a normative sample for the Brief Test of Adult Cognition by Telephone (BTACT), a short cognitive battery adapted for telephone administration and validated for the TBI population; (2) examine the relationship …

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Adolescent Overweight And Obesity In Ireland—Trends And Sociodemographic Associations Between 1990 And 2020, Aoibhín Moore Heslin, Aisling O'Donnell, Laura Kehoe, Janette Walton, Albert Flynn, John Kearney, Breige Mcnulty Jan 2023

Adolescent Overweight And Obesity In Ireland—Trends And Sociodemographic Associations Between 1990 And 2020, Aoibhín Moore Heslin, Aisling O'Donnell, Laura Kehoe, Janette Walton, Albert Flynn, John Kearney, Breige Mcnulty

Articles

Background: Overweight and obesity in adolescence is a growing issue and can have a range of both short- and long-term consequences on health. Objectives: To analyse trends in adolescent weight status in Ireland across a 30-year period and to examine the influence of sociodemographic factors on overweight/obesity in Irish adolescents over time. Methods: Body composition and body mass index weight status of Irish adolescents were compared using data from three nationally representative, cross-sectional Irish national food consumption surveys from 1990, 2006 and 2020. Adjusted analysis of associations between socio-demographic factors with the risk of adolescent overweight/obesity at each time point …

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Gender Equality In Ocean Science For Sustainable Development : Analysis Of Ocean Science Institutions In Kenya, Renis Auma Ojwala Jan 2023

Gender Equality In Ocean Science For Sustainable Development : Analysis Of Ocean Science Institutions In Kenya, Renis Auma Ojwala

World Maritime University Ph.D. Dissertations

Gender inequality poses a serious problem for national and international developmental programmes such as the United Nations Decade of Ocean Science for Sustainable Development (the Ocean Decade) and appears in both developed and developing countries. The fundamental aim of the Ocean Decade is to improve ocean health worldwide through generating knowledge, supporting innovations, discovering creative ideas and developing solutions to achieve equitable and sustainable development under the changing environmental, social and climate conditions. The paucity of women in ocean management has been documented as a major hindrance to ocean sustainability and a top challenge to diversity in workplaces because of …

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America Is Watching, But Are They Listening?, Nancy Kartos Jan 2023

America Is Watching, But Are They Listening?, Nancy Kartos

Cardozo Arts & Entertainment Law Journal

The note examines the persistent issue of violence against Black people, particularly at the hands of police, and how social media has become a significant factor in hindering accountability. It draws historical parallels between past racial violence, such as lynchings during the Jim Crow era, and contemporary police brutality, highlighting how social media amplifies yet polarizes public discourse. The analysis critiques the legal system's failure to hold police accountable, with a focus on the doctrine of qualified immunity, and explores how political polarization exacerbates the problem. The note ultimately argues that without addressing these systemic and technological challenges, meaningful reform …

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