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Racial Differences In Adverse Pregnancy Outcomes And Incident Hypertension: A Mediation Analysis, Lucia C. Petito, Xiaoning Huang, C. Noel Bairey, Natalie Bello, Janet Catov, Ernesto Licon, Abbi Lane, David M. Haas, Lisa D. Levine, Rebecca B. Mcneil, Eliza Miller, Uma M. Reddy, Bethany Barone Gibbs, George Saade, Lauren Theilen, Laura E. Wiener, Brian M. Mercer, Hyagriv N. Simhan, Lynn M. Yee, Philip Greenland, William A. Grobman, Sadiya S. Khan

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black-White hypertension disparities remains unknown.

Methods

The nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be-Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010-2013) with follow-up 2 to 7 years postpartum (2014-2017). Race, which represents a social construct, was self-identified. The primary outcome was incident hypertension at follow-up. APOs included hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) …

Biomechanical Integrity Of The Female Pelvic Floor: A Comparison Of Military And Civilian Women, Vladimir Egorov, Peter Takacs, Vincent Lucente, Heather Van Raalte, Joy A. Greer, Noune Sarvazyan

Department of Obstetrics & Gynecology Faculty Publications

Introduction

The health of the pelvic floor depends on the integrity of its muscles, connective tissue, ligaments, and their innervation. The female pelvic floor may be more vulnerable to repetitive heavy loads in a military environment than the male pelvic floor because of anatomical and physiological differences. The study aim was to identify and explore possible differences in the female pelvic floor conditions between active military and civilian women with similar demographics.To identify and explore possible differences in the conditions of the female pelvic floor between active military women and civilian women with similar demographics.

Materials and Methods

Military active …

Understanding Resilience In Children In Out-Of-Home Care: Using Person-Centered Health Services Research, Hyeeun K. Shin

Theses and Dissertations--Health Services Research (HSR)

Adverse childhood experiences (ACEs), which refer to exposure to traumatic life events before age 18, and instability in caregiving experiences contribute to poor physical, mental, behavioral, and developmental health outcomes for both children and adults. Previous research shows that these experiences can have negative effects both in the short term and throughout a person’s life. However, children’s strengths, which are the internal and external assets that support their development, can help protect against the impact of ACEs. Effective parenting, positive social support, and self-regulation skills are essential factors that build resilience, helping individuals adapt to challenges that may affect their …

Human Rights Education For Children And Youth On Human Rights And Digital Technologies, Diane A. Desierto, Faisal Yamil Meneses, Notre Dame Global Human Rights Clinic

Journal Articles

AI Generated Summary

This document outlines the importance of human rights education for children and youth, particularly in relation to digital technologies, emphasizing the need for comprehensive, inclusive, and accessible educational frameworks.

Gendered Resistance: Women’S Strategies Against Military Dictatorships, Argentina And Chile, Maricarmen Canales-Moreno

Publications and Research

This article compares the Madres de Plaza de Mayo in Argentina and the Agrupación de Familiares de Detenidos Desaparecidos (AFDD) in Chile to examine how women transformed their identities as mothers, wives, and daughters into strategies of political resistance under military dictatorship. It argues that maternal imagery, public mourning, and the transformation of private grief into collective defiance enabled women-led human rights organizations to challenge authoritarian regimes while strategically drawing on gender roles those regimes sought to enforce. The article traces the emergence of both organizations, their occupation of public space, hunger strikes, legal action, and engagement with international human …

Insurance Disparities In Hidradenitis Suppurativa: A Comprehensive Review Of Demographics, Outcomes, And Access To Care, Alim Osman, Alexandra R. Nigro, Michael C. Povelaitis, Marc Z. Handler

Department of Medicine Faculty Publications

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that disproportionately affects women, African Americans, and individuals of biracial descent. It is associated with substantial physical and psychiatric morbidity, reducing quality of life.

Objective: This review analyzed disparities in treatment outcomes, disease progression, and healthcare access among HS patients based on insurance type.

Methods: Using PRISMA guidelines, a comprehensive literature search identified 7 studies meeting inclusion criteria. Owing to data heterogeneity, studies were qualitatively analyzed.

Results: Findings consistently demonstrated that Medicaid patients experienced worse outcomes than those with private insurance or Medicare. Medicaid patients had higher rates of comorbid …

Follow The Cyclists: Everyday Navigation Of Richmond's Bike Infrastructure, Emily E. Schreer

Theses and Dissertations

This thesis explores the embodied experience of cycling in Richmond, emphasizing the importance of centering firsthand, lived experience in cycling research and urban planning. While traditional transportation planning can often myopically prioritize efficiency and safety metrics to evaluate infrastructure, this project argues that such approaches overlook essential experiential, sensory, and emotional dimensions of cycling that determine how infrastructure is perceived, used, and ultimately succeeds or fails.

Through an ethnographic approach combining field observation of cyclist behavior and mental mapping sessions with Richmond cyclists, this study positions people who bike in Richmond as expert knowledge holders. Participant contributions, combined with observations …

Putting The L In Elsi: Legal Methods For Bioethics Research, Anya E R Prince, Benjamin Berkman, Donald Ford, Dov Fox, Christi Guerrini, Amy Koopmann, Natalie Ram, Jessica L Roberts, Kayte Spector-Bagdady, Sonia Suter

Center for Medical Ethics and Health Policy Staff Publications

Lawyers and law professors are increasingly involved in interdisciplinary scientific teams and grant research to answer ethical, legal and policy questions related to biomedical topics. Yet, the methods that lawyers use to conduct legal research and analysis are not always familiar to scientists and social scientists conducting peer review of a proposed project with legal aims or a publication reporting a legal study. To better facilitate interdisciplinary ethical, legal, and social implications collaboration, there is a need to better explain how legal research methodologies can provide robust tools to address a range of nuanced biomedical questions. This paper explores …

Differences Between Government, Consortium, And Private Database Stewards Impacting The Genomic Data Market: A Survey Of U.S. Academic Genetic Researchers., Amanda K Greene, J Denard Thomas, Kaitlyn Jaffe, Luyun Chen, Kerry A Ryan, Brian J Zikmund-Fisher, J Scott Roberts, Amy L Mcguire, Katherine Hendy, Kayte Spector-Bagdady

Center for Medical Ethics and Health Policy Staff Publications

Background: Despite major shifts in U.S. federal government data sharing requirements, their impact, and relation to researcher choice of database, are underexplored. This study surveyed genetic researchers regarding trends, priorities, perceptions of quality, impact on research outcomes, and genomic data sharing and use across government, consortium, and private databases.

Methods: As part of an exploratory sequential mixed methods project, we surveyed 294 U.S.-based genomic academic researchers.

Results: Genetic researchers generally have a choice between databases, which allows them to prioritize data quality. This might explain recent trends toward the use of government and consortium databases away from private ones. Respondents …

Access To Digital Health Technologies: Personalized Framework And Global Perspectives, Sanjiv M Narayan, Mina K Chung, Demilade Adedinsewo, Luisa C C Brant, Leslie L Davis, David Duncker, Jennifer L Hall, Janet K Han, Carolyn S P Lam, Eldrin Lewis, Joseph Loscalzo, Manlio F Márquez, Vasiliki Rahimzadeh, Fatima Rodriguez, Prashanthan Sanders, Emma Svennberg, Kenneth Stein, Mintu Turakhia, Clyde Yancy, Antonis A Armoundas

Center for Medical Ethics and Health Policy Staff Publications

The emergence and rapid adoption of digital health technologies (DHT) present unprecedented opportunities to democratize and reduce disparities in health care by monitoring health and disease at the point of care in all patients. However, limited access to DHT is becoming a major obstacle to realizing these goals. Access to DHT is influenced not only by well-recognized social determinants of health, but also by digital determinants of health, such as digital literacy and the need for broad access to digital infrastructure, as well as commercial and economic factors. Addressing these challenges and designing unbiased systems of care are essential to …

Imagining Genomics And Population Health In 2050: Anticipating Future Research, Policy, And Governance Needs, Bartha Maria Knoppers, Yann Joly, Ma Apos N H Zawati, Habiba Alsafar, Jeffrey C Barrett, Laura Blackburn, Brian Hon-Yin Chung, Martina C Cornel, Edward S Dove, David Glazer, Calvin Wai-Loon Ho, Muin J Khoury, Anna C F Lewis, Anneke Lucassen, Peter F R Mills, Colin Mitchell, Nicola Mulder, Ainsley J Newson, Anthony Ng, Paul D P Pharoah, Vasiliki Rahimzadeh, Megan C Roberts, Saskia C Sanderson, Jeffrey M Skopek, Ron Zimmern, Eric M Meslin

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

Nuclear Deterrence And Nuclear Modernization: A Strategic Analysis Of Global Nuclear Threats And U.S. Policy, Abraham Morland

Graduate Theses/Dissertations

The nuclear imperative comes from the idea that all three legs of the Triad must be retained to ensure a viable deterrent posture, provide flexibility in a response, and give decision makers options to create uncertainty in an adversary’s decision calculus. The nuclear imperative is the need to fund suggested shortfalls in the nuclear enterprise and modernize the U.S. Triad, not just one or two legs, but all three, due to the ever-increasing nuclear risk. To understand the current state in which the United States finds itself and the need for the nuclear modernization program, this thesis will review nuclear …

Drone Dichotomy: Investigating The Application Of Unmanned Aerial Systems For Offensive And Defensive Chemical, Biological, Radiological, And Nuclear-Related Tasks, Evan Jacob Martinovitch

Graduate Theses/Dissertations

This thesis investigates the application of unmanned aerial systems (UAS) for both offensive and defensive chemical, biological, radiological, and nuclear (CBRN) tasks to determine if they serve as a force multiplier on the modern battlefield. As CBRN weapons reemerge as realistic threats alongside the rapid proliferation of UAS, the intersection of these fields presents unique challenges and opportunities. Through a methodology that examines the history of the UAS-CBRN intersection, military doctrine, and the status of UAS technology, this research evaluates the capability of current and emerging UAS against specific CBRN delivery, reconnaissance and surveillance, and decontamination tasks. The analysis conducted …

Northern Luzon In A Taiwan Flashpoint: The Philippines’ Place In U.S. Strategy, Carson Keller

Graduate Theses/Dissertations

While the defense of Taiwan from a potential invasion by the People’s Republic of China (PRC) has long been a topic of debate and scrutiny in U.S. strategic thinking, the role of its southern neighbor, the Philippines, has received far less attention. This thesis argues that northern Luzon would constitute key terrain in a cross-strait conflict and may become an early target of People’s Liberation Army (PLA) operations. Its proximity to Taiwan and position along the Luzon Strait, particularly the Bashi Channel, places it at the center of efforts to control access to the hypothetical battlespace. Drawing on PLA and …

Europe In The Indo-Pacific - Implications For The United States, Joshua G. Zinicola

Graduate Theses/Dissertations

Within the last five years the Indo-Pacific has become a region of increasing interest to European NATO members. In particular, the United Kingdom, France, and Italy have assigned strategic importance for their national security to the region, signing cooperative agreements with regional allies of the United States and deploying significant forces to the region. These agreements include commitments to jointly develop new technologies and combat systems for employment in both Europe and the Indo-Pacific, such as the Global Combat Air Programme (GCAP), and the Trilateral security partnership between Australia, the United Kingdom, and the United States (AUKUS). They also include …

The Ones Who Watched: Technology, Proxy Warfare, And The Testing Ground Hypothesis, Sean J. Oliver

Graduate Theses/Dissertations

Great powers need laboratories for war. This thesis argues that great powers find these laboratories in proxy forces. Proxy warfare is not just a tool for strategic influence. It is a machine for experimentation. This study posits a central testing-ground hypothesis. It contends that great powers deliberately use surrogates to vet emerging technologies, doctrines, and mobilization schemes under the pressure of real combat. The analytical methodology is historical. It traces patterns from the ancient world's proxy forces and the innovations of the Crusades to the Cold War and the digital age. The thesis examines enduring patterns, including the tension between …

Organ Chips And Translational Research: Identifying And Examining New Ethical Issues, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

Organ chips, also known as organ-on-a-chip devices, tissue chips, or microphysiological systems, have emerged over the last decade as a promising translational technology amidst growing concern about the translational crisis between laboratory research and patient bedside. Pointing to high rates of failure between nonhuman animal models and safety and efficacy in humans, organ chips and similar new approach methods have attracted substantial public and private investment. As human-cell-based alternatives to animal models, organ chips promise more predictive, efficient, and ethical platforms for pharmaceutical and toxicity testing. Engineered cultivation systems that enable cells to assemble into tissue-like structures (e.g. kidney, brain, …

Anything But Endo: Diagnostic Buck-Passing In Endometriosis Diagnosis, Rita Dexter, Megan Kitts, Heather Welty, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in-depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck-passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing …

Can I Get A Witness? The Ethical Dimensions Of Family Presence In Patient Suffering, Jennifer Blumenthal-Barby, Trevor M Bibler, Holland Kaplan, Adam Omelianchuk, Joanna Smolenski

Center for Medical Ethics and Health Policy Staff Publications

For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing …

Toward Ethical Provenance Tracking: The Ga4gh Model Data Access Agreement (Daa), Alexander Bernier, Bartha Maria Knoppers, Jonathan Lawson, Robyn Mcdougall, Maili Raven-Adams, Vasiliki Rahimzadeh

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Standardizing contractual clauses that govern data access enables research institutions to responsibly steward genomic and related health data while enabling its efficient downstream reuse.

Methods: We describe a document analysis study using both qualitative and comparative law analytical approaches to identify the most common categories of clauses from 29 different data access agreements used by human biomedical research consortia globally. We furthermore characterized the legal positions and standard practices for each common element of the agreement and synthesized across them to develop model clauses. A total of 3 discussion sessions were organized virtually to refine the clauses among members …

Clinicians’ Views On A Patient Decision Aid For Deep Brain Stimulation In Parkinson’S Disease, Hillary S King, Jennifer Blumenthal-Barby, Benjamin H Levi, Sol De Jesus, Harini Sarva, Laura Y Cabrera

Center for Medical Ethics and Health Policy Staff Publications

Introduction: For people with Parkinson's disease (PD), deciding whether to pursue deep brain stimulation (DBS) has become increasingly complex. Evidence suggests current approaches to collaborative decision-making may fall short of accepted standards. Thus, a decision support intervention, such as a patient decision aid (PtDA) may be warranted. PtDAs have been shown to improve patients' knowledge, expectations, and participation in decision-making for other, similar healthcare decisions. We therefore sought to assess neurologists' awareness of, and experience using, PtDAs, and to solicit their opinions on the ideal features of a PtDA for PD patients considering DBS.

Methods: Sixteen United States-based neurology clinicians …