Public Affairs, Public Policy and Public Administration Commons^™

Black Birth Work As Radical Praxis: A Hermeneutic Phenomenological Inquiry Of Leadership Among Black Birth Workers, Lesa C. Clark

Antioch University Dissertations & Theses

This hermeneutic phenomenological study explores the leadership experiences of Black birth workers (BBWs), revealing critical insights into leadership dynamics within maternal healthcare. Through a theoretical framework integrating African feminism, Black feminism, and anti-racist feminism, the research examines how BBWs conceptualize and enact leadership through embodied, relational, and liberatory approaches. This study addresses a significant gap in leadership literature, particularly regarding generational knowledge and practices of BBWs, which remain understudied despite their vital role in Black maternal healthcare. This study reveals distinct leadership perspectives and methodologies through in-depth interviews with eight BBWs and a detailed interpretive analysis. The findings contribute to …

Complexity, Polycentricity, And Climate Change: An Embedded, Multi-Level Case Study Of A Climate Meta-Network, Timothy Staub

Antioch University Dissertations & Theses

The earth is in crisis, and without urgent, systemic, and collective global action to address the emerging threat of climate change, we will continue to see catastrophic events impacting humanity, threatening our very survival in many regions of the world. Temperatures will rise, ice shelves will melt, seas will rise, crops will fail, water scarcity from drought and new weather patterns will increase and spread, wildfires will accelerate, and food and water insecurity, violence, and the largest human migration in history will ensue. These climate crises will displace over 1.2 billion people by 2050 at a rate currently exceeding 21.5 …

Ethical Imperatives For Rational Paternalism In Advisor-Client Relationships, Igor A. Zey

Antioch University Dissertations & Theses

This study seeks to understand the role of ethics and rational paternalism in the practice of financial advising. A significant amount of research examines the effects of rational paternalism on the governmental and institutional levels. Very little research has addressed the issues associated with rational paternalistic behavior by advisors toward their clients. Investopedia (2013) focuses on advisors’ ethics and moral responsibilities, underscoring the ethical standards clients should expect from their financial advisors. However, practically none of the literature examines the ethics, morals, and practical aspects of individual paternalism. In response, this study examines the concept of rational paternalism in advisor-client …

Embracing The Suck: Overcoming Moral Injury-Related Attachment Trauma Through Outdoor Adventure, Emerald D. Ralston

Antioch University Dissertations & Theses

Moral injury is increasingly recognized as a distinct and debilitating consequence of military service, arising when individuals engage in, witness, or are unable to prevent actions that transgress their deeply held moral beliefs. In this dissertation, I argue that this form of trauma can be experienced as an attachment rupture, particularly when the military—functioning as an institutional attachment figure—betrays the servicemember’s trust. Such experiences compromise internal working models (IWMs) of self, others, and the world, and may result in complex trauma symptoms, including dissociation, depersonalization, and profound relational disconnection. These injuries are frequently stored in the body, rendering traditional cognitive …

Adults Drug Court Model's Review: A Case Study, Byron R. Titus

Antioch University Dissertations & Theses

In 1989 Dade County, Florida, the so-called “War on Drugs” was in full swing. As a result, drug courts were created, acting as a diversion program for the many people subsequently caught up in this “war.” Since then, such “specialty courts” have proliferated across the planet. In some cases, local versions have been adopted to adjust to their unique population, culture, risk, and needs. This dissertation is a case study that reviews three Intensive Probation Supervision Programs (IPSP). These IPSPs identify a drug court in their state or country before it becomes a “certified drug court” (now more often referred …

Journey To Well-Being: An Exploration Of Thrivership Post-Domestic Violence, Kader Gumus

Antioch University Dissertations & Theses

Domestic violence profoundly affects multiple facets of a survivor’s life. While most existing literature on survivorship addresses the immediate aftermath of domestic violence, this study delves into the extended process following the trauma of abuse to attain “thrivership,” a new concept in the scholarly and practice literature that emphasizes enduring well-being and flourishing. This dissertation examines the journeys from surviving to thriving for 13 women who transformed themselves and their lives to achieve well-being after traumatic domestic violence. Bronfenbrenner’s ecological systems theory was applied to examine the multiple layers of environmental influences on an individual’s development, including the micro, meso, …

Multi-Risk Governance Of Solar Radiation Modification, Jonathan B. Wiener, Tyler Felgenhauer, Mark E. Borsuk

Faculty Scholarship

Solar radiation modification (SRM) presents important challenges to risk regulation and governance, arising from the array of multiple risks that SRM may influence. SRM would not simply reverse climate change, but could pose further ancillary impacts, depending on the method of SRM, such as stratospheric aerosol injection (SAI), marine cloud brightening (MCB), or a space-based planetary sunshade system (PSS). We identify multiple risks that SRM may influence, both biophysical and sociopolitical, to be compared to the multiple risks that may be affected by greenhouse gas (GHG) mitigation and climate adaptation. This multi-risk framework helps analysts and decision makers identify, evaluate, …

Assisted Living, Residential Care, And Memory Care Staffing Level Dynamics: Oregon, 2017–2023, Sarah Dys, Ozcan Tunalilar

Institute on Aging Publications

Objectives

To examine changes in staffing levels over time in Oregon assisted living and residential care (AL/RC) communities between 2017 and 2023.

Design

Longitudinal study of licensed AL/RC communities.

Setting and Participants

A total of 1720 setting-year observations from 535 individual AL/RC communities in Oregon between 2017 and 2023.

Methods

Primary data were collected through the Oregon Community-Based Care (CBC) study. Staffing levels were estimated as care staff hours per resident per day and reported overall and by staff type, including registered nurses, licensed practical nurses, certified nursing assistants, certified medication aides, unlicensed care staff, life enrichment staff, and social …

Factors Contributing To Fatalities In Helicopter Emergency Medical Service Accidents, Jenna Korentsides, Joseph R. Keebler, Mihhail Berezovski, Alex Chaparro

Publications

INTRODUCTION: T his study aimed to update and reinforce previous research on helicopter emergency medical service accidents in the United States. By investigating predictors of fatalities after helicopter emergency medical service crashes through the application of machine learning techniques, we updated existing data sets and sought to uncover patterns that traditional analysis might not reveal.

METHODS: Using the National Transportation Safety Board database, the authors analyzed a dataset of 267 helicopter emergency medical service accidents between 1991–2022. We first calculated fatalities odds ratios for each condition. We then plotted geospatial locations of all reported accidents. Finally, we used XGBoost regression …

Position: Benchmarking Is Broken - Don't Let Ai Be Its Own Judge, Zerui Cheng, Stella Wohnig, Ruchika Gupta, Samiul Alam, Tassallah Abdullahi, João Alves Ribeiro, Christian Nielsen-Garcia, Saif Mir, Siran Li, Jason Orender, Seyed Ali Bahrainian, Daniel Kirste, Aaron Gokaslan, Carsten Eickhoff, Pramod Viswanath, Ruben Wolff

Computer Science Faculty Publications

The meteoric rise of Artificial Intelligence (AI), with its rapidly expanding market capitalization, presents both transformative opportunities and critical challenges. Chief among these is the urgent need for a new, unified paradigm for trustworthy evaluation, as current benchmarks increasingly reveal critical vulnerabilities. Issues like data contamination and selective reporting by model developers fuel hype, while inadequate data quality control can lead to biased evaluations that, even if unintentionally, may favor specific approaches. As a flood of participants enters the AI space, this "Wild West" of assessment makes distinguishing genuine progress from exaggerated claims exceptionally difficult. Such ambiguity blurs scientific signals …

Uncertainty-Aware Deep Learning Framework For Forecasting Coastal Water Level In Virginia Beach, Md Mahmudul Hasan, Malachi Schram, Sridhar Katragadda, Diana Mcspadden, Alisa N. Udomvisawakul, Heather Richter, Frank Liu

Computer Science Faculty Publications

Coastal areas like Virginia Beach, USA, are increasingly vulnerable to flooding. To mitigate the impact of flooding, it is crucial for the City of Virginia Beach to have reliable 72-hour-ahead (3 days) forecasts of water levels at key gauge locations. To support this effort, several sensors have been installed throughout the city to monitor water levels and other environmental parameters such as wind speed, precipitation, and atmospheric pressure. Leveraging sensor data from one of these locations, we developed an uncertainty-aware deep learning model to forecast water levels. We employed deep quantile regression (DQR) to quantify variability in the predictions and …

Effects Of Actualized Language Policy On Ukrainian Stability, 1989-2022, Dawn Hersey

Electronic Theses & Dissertations (2024 - present)

This dissertation seeks to generate a new perspective of the complicated relationship between actualized policy and stability through looking at Ukraine’s language policies and stability in a mixed manner approach that includes both primary and secondary sources. Russia justified its irridentist activities through claiming to protect Russian nationals within Ukraine’s borders: language policies within Ukraine appear to be a trigger for Russian antagonism. Neither Russian irridentism nor Ukrainian nationalism are being considered as right or wrong in this dissertation: the intent is to highlight trends, patterns, and perceptions in alignment with Ukrainian language policy. This dissertation does not present a …

A Study Of Regulatory Compliance In U.S. Nursing Homes, Patrick Schumacher

Electronic Theses & Dissertations (2024 - present)

The federal government is responsible for ensuring that nursing homes comply with regulations designed to protect residents from abuse, neglect, and substandard care. To this end, the Centers for Medicare and Medicaid Services (CMS) partners with states to conduct onsite inspections of nursing homes, during which regulators may identify violations. The agency can take one or more actions in response to violations, including imposing civil money penalties (fines), appointing a state monitor, or mandating remedial education for staff. Despite this regulatory framework, the quality of care in nursing homes remains poor, with many facilities failing to protect the well-being of …

Challenges In Financial Prosperity: Cutback Management And Bounded Rationality In New York State School Districts, Moontae Hwang

Electronic Theses & Dissertations (2024 - present)

The Great Recession posed unexpected fiscal challenges for public sector entities, particularly small and mid-sized organizations such as school districts, which operate with limited revenue flexibility and constrained managerial capacity. While the recession was a macroeconomic event, which could be an exogenous shock to state and local governments beyond their control, state and local policy responses played a critical role in shaping its long-term effects on local public services. Scholars have emphasized the importance of long-term perspectives among policymakers and public managers to sustain the quality of public services during crises. However, the heightened uncertainty of the recession also constrained …

Socio-Economic And Infrastructural Determinants Of Response Time Disparities Across Emergency Service Agencies, Alice N. Ottah

Electronic Theses & Dissertations (2024 - present)

This study comprehensively analyzes the determinants of disparities in emergency response times for EMS, Fire, and Police agencies in San Francisco from 2021 to 2023, utilizing a multilevel modeling framework and publicly accessible data. Contrary to a primary reliance on structural neighborhood factors, this research reveals that while neighborhood disadvantage statistically significantly interacts with agency type to influence response times, its direct effect is weak and not uniformly consistent across services. Specifically, the analysis demonstrates that variance in call response times across neighborhoods is minimal (Intraclass Correlation Coefficients < 0.02), the effects of disadvantage are agency-specific (null effects for Police and Fire), and even when significant (for EMS calls only), response times are faster in more disadvantaged neighborhoods. These findings challenge the existing literature on emergency response times and highlight the need for tailored policy interventions that consider both neighborhood context and agency-specific operations to promote equitable emergency response.

Naloxone Availability And Affordability: An Analysis Of Pharmacies Across New York State, Dina R. Maloney

Electronic Theses & Dissertations (2024 - present)

The United States (US) has experienced a significant increase in the number of opioid overdose deaths since 1999. Drug overdoses are now the leading cause of accidental death in the US, surpassing other injury causes such as motor vehicle accidents. Opioids are most commonly associated with drug overdose deaths. The opioid overdose reversal medication naloxone, commonly known by the brand name Narcan®, has gained popularity in recent years as a critical tool for reducing the number of opioid overdose deaths. Naloxone Access Laws (NALs) and standing orders have been implemented by states nationwide in an effort to increase the availability …

Managing Artificial Intelligence In The Public Sector: Adoption, Implementation, And Results, Tzuhao Chen

Electronic Theses & Dissertations (2024 - present)

With the rapid advancement of artificial intelligence (AI), governments around the world are increasingly exploring how AI can enhance decision-making and improve public service delivery. A growing body of research has examined governmental use of AI, offering insights into several key areas: (1) domains of application, (2) potential benefits and risks of AI initiatives, and (3) adoption and implementation processes, including critical determinants and results. However, two significant gaps remain in the literature. First, there is limited understanding of how the unique characteristics of AI may transform government service delivery and internal operations. Second, while many studies on AI-related managerial …

Three Essays On Addressing Conflicts And Consensus During Energy Transitions, Paul Inseok Jo

Electronic Theses & Dissertations (2024 - present)

Addressing the current climate crisis becomes more urgent, but also controversial. This is because the move toward a renewable energy system tends to produce new winners and losers by generating disproportionate outcomes across different stakeholders. Given this context, more actors and organizations are engaged in the policymaking process of energy transitions while competing or cooperating to defend their interests and values. Therefore, it is pivotal to understand these dynamic interactions to achieve a just transition based upon energy justice. This research thus strives to respond to this research question: How can different coalitions and stakeholders reach consensus by mitigating tensions …

The Invisible Costs Of Privatizing Welfare: Administrative Burdens In Contracted Medicaid, Soyun Jeong

Electronic Theses & Dissertations (2024 - present)

Why do governments favor contracting out social services? Do private actors guarantee a better service experience for citizens? How should we understand the trade-off between efficiency and high-quality service delivery? These are the central questions that motivate this dissertation. Focusing on Medicaid, one of the largest social safety net programs in the United States, this dissertation investigates the impact of outsourcing Medicaid delivery to private health insurance companies. It explores how this privatized structure generates administrative burdens and shapes policy feedback effects. Theoretically, this project seeks to bridge the administrative burden and policy feedback literature by examining how burdensome policy …

Officers’ Perceptions Of Body-Worn Cameras: An Exploratory Study Of Small Police Departments In Upstate New York, Stefan A. Dela Riva

Electronic Theses & Dissertations (2024 - present)

The aim of this exploratory study is to examine how police officers perceive the impact of body-worn cameras (BWCs) on their use of discretion when communicating with members of the public. In this context, “discretion” refers to an officer’s authority to make independent judgments while enforcing the law; deciding whether to issue a warning, make an arrest, or resolve an incident informally when legality permits. To understand officers’ opinions, a cross-sectional, quantitative online survey was distributed to various police departments and sheriff’s offices in upstate New York. Participants completed a series of Likert-style survey items addressing their general views on …

Different Responses Involving Tfh Cells Delay Parasite-Specific Antibody Production In Trypanosoma Cruzi Acute Experimental Models, Ana Carolina Leão, Maria Jose Villar, Rakesh Adhikari, Cristina Poveda, Leroy Versteeg, Gregório Almeida, Peter J Hotez, Maria Elena Bottazzi, Kathryn M Jones

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Chagas disease (CD), caused by the parasite Trypanosoma cruzi, affects millions globally. Despite treatment options in the acute phase, most infections progress to a chronic indeterminate form or develop severe cardiac/gastrointestinal complications. Understanding the immune response is crucial for the development of vaccines and more efficient drugs for the disease control.

Methods: This work investigates the immune response to T. cruzi H1 K68 strain infection in female BALB/c and C57BL/6 mice to characterize differences in Tfh and B cell responses that may be involved in the poor parasite-specific antibody production during acute infection. For this, mice were euthanized …

Talking About Suffering In The Intensive Care Unit, Brent M Kious, Judith B Vick, Peter A Ubel, Olivia Sutton, Jennifer Blumenthal-Barby, Christopher E Cox, Deepshikha Ashana

Center for Medical Ethics and Health Policy Staff Publications

Background: Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients' families.

Methods: We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from 2012-2017 to look at how the term "suffering" and its variants were used. A coding guide was developed by consensus-oriented discussion …

Methadone For Critically Ill Patients Under Mechanical Ventilation In The Intensive Care Unit: A Systematic Review, Sérgio Martins Pereira, Megan Abbott, João Francisco Figueiredo Marcondes Ferraz, Akash Goel, Andrea Rigamonti, Charmaine De Castro, Lisa Burry, Airton Leonardo De Oliveira Manoel, Michael Chaim Sklar

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Pain may pose significant challenges in the intensive care unit, especially in mechanically ventilated patients. Methadone has recently emerged as an alternative option for eliciting acute analgesia. In this systematic review, we evaluated the use of methadone in mechanically ventilated patients in the intensive care unit.

Source: We searched MEDLINE, EMBASE, Wiley's Cochrane Library, CINAHL, PubMed (non-MEDLINE), Scopus, and LILACS databases from inception to January 24th, 2025. Eligible studies included randomized controlled trials and observational studies that compared the use of methadone to the standard of care or to other analgosedation strategies in mechanically ventilated patients in the intensive …

When Families Bridge The Research-Clinical Divide: An Exploration Of Values Regarding Cascade Screening In Genomic Research, Katherine E Bonini, Lauren R Desrosiers-Battu, Ann Katherine M Foreman, Nuriye N Sahin-Hodoglugil, Mary A Majumder, Candice R Finnila, Stephanie A Kraft, Laura M Amendola, Eimear E Kenny, Stephanie M Fullerton, Sara L Ackerman, Benjamin S Wilfond, Amy L Mcguire, Hadley Stevens Smith

Center for Medical Ethics and Health Policy Staff Publications

Purpose: Genetic results are important for both patients and their biological relatives. However, cascade screening (CS) uptake is low, especially when testing occurs through research programs and not clinical care. Ethical guidance is needed for CS implementation when individuals receive clinical genetic results through research.

Methods: We conducted focus groups with 3 groups of individuals in the Clinical Sequencing Evidence-Generating Research Consortium: clinicians, patient representatives, and scholars of the ethical, legal, and social implications of genomics. We used inductive thematic and comparative analyses to analyze data within and across the groups.

Results: All participants (n = 27) agreed that …

Adolescent And Caregiver Preparation For Legal Changes At Age 18, Blanca Sanchez-Fournier, Jordyn Babla, Mary Majumder, Beth H Garland, Constance M Wiemann, Albert C Hergenroeder

Center for Medical Ethics and Health Policy Staff Publications

Background: Most adolescents with special healthcare needs (ASHCN) will assume legal responsibility for making decisions about their medical treatment at age 18. Simultaneously, parents or other legal representatives (Caregivers) will lose ASHCN medical record access. This study examined ASHCN and Caregiver knowledge of, satisfaction with, and suggestions for improvement in preparing for these changes.

Methods: Eighty-three dyads (18-year-old ASHCN and Caregivers) completed an assessment to evaluate their knowledge about changes in responsibility for decision making with a focus on consent, satisfaction with the preparation received, and recommendations for improved preparation. Descriptive statistics and mean comparisons were used. Responses to open-ended …

Deep Brain Stimulation For Childhood Treatment-Resistant Obsessive-Compulsive Disorder: Mental Health Clinician Views On Candidacy Factors, Ilona Cenolli, Tiffany A Campbell, Natalie Dorfman, Meghan Hurley, Jared N Smith, Kristin Kostick-Quenet, Eric A Storch, Jennifer Blumenthal-Barby, Gabriel Lázaro-Muñoz

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Deep brain stimulation (DBS) is approved under a humanitarian device exemption to manage treatment-resistant obsessive-compulsive disorder (TR-OCD) in adults. It is possible that DBS may be trialed or used clinically off-label in children and adolescents with TR-OCD in the future. DBS is already used to manage treatment-resistant childhood dystonia. Evidence suggests it is a safe and effective intervention for certain types of dystonia. Important questions remain unanswered about the use of DBS in children and adolescents with TR-OCD, including whether mental health clinicians would refer pediatric patients for DBS, and who would be a good candidate for DBS.

Objectives: …

Impact Of Personalized Risk Scores On Shared Decision Making In Left Ventricular Assist Device Implantation: Findings From A Qualitative Study, Holland Kaplan, Kristin Kostick-Quenet, Benjamin Lang, Robert J Volk, Jennifer Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

Objective: To assess stakeholders' perspectives on integrating personalized risk scores (PRS) into left ventricular assist device (LVAD) implantation decisions and how these perspectives might impact shared decision making (SDM).

Methods: We conducted 40 in-depth interviews with physicians, nurse coordinators, patients, and caregivers about integrating PRS into LVAD implantation decisions. A codebook was developed to identify thematic patterns, and quotations were consolidated for analysis. We used Thematic Content Analysis in MAXQDA software to identify themes by abstracting relevant quotes.

Results: Clinicians had varying preferences regarding PRS integration into LVAD decision making, while patients and caregivers preferred real-time discussions about PRS with …

Advancing Medical Applications Of Cancer Nanotechnology: Highlighting Two Decades Of The Nci's Nanotechnology Characterization Laboratory Service To The Research Community, Rachael M Crist, Yechezkel Barenholz, Ahuva Cern, Kate N Clark, Pieter R Cullis, Cheryl Dean, Neil Desai, Mauro Ferrari, Matthieu Germain, Carmen A Giacomantonio, Emma Grabarnik, Piotr Grodzinski, Atara Hod, Barry E Kennedy, Ruvanthi N Kularatne, Glen S Kwon, Emmanuel Loeb, Erin B Noftall, Len Pagliaro, Morteza Rasoulianboroujeni, Alexander Roth, Darren Rowles, Kulbir Singh, Nicole F Steinmetz, Zhanna Yehtina, Yao Zhang, Daniel Zilbersheid, Jeffrey D Clogston, Stephan T Stern, Marina A Dobrovolskaia

Center for Medical Ethics and Health Policy Staff Publications

The Nanotechnology Characterization Laboratory (NCL) is a US federally funded resource providing characterization and expertise to the cancer nanomedicine research community. Founded as a formal partnership among the US National Cancer Institute (NCI), the US Food and Drug Administration (FDA), and the US National Institute of Standards and Technology (NIST), the NCL has spent two decades developing a one-of-a-kind service with broad multidisciplinary expertise to meet the needs of a rapidly evolving drug development field. To mark the 20th anniversary of the lab's founding, the NCL hosted a symposium to highlight the achievements of the cancer nanomedicine field, showcase novel, …

Investigative Genetic Genealogy Practices Warranting Policy Attention: Results Of A Modified Policy Delphi, Christi J Guerrini, Louiza Kalokairinou, Jill O Robinson, Whitney Bash Brooks, Stephanie M Fullerton, Sara Huston, Jacklyn Dahlquist, Diana Madden, Norah Crossnohere, Nicola Campoamor, John F P Bridges, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

A technique known as investigative genetic genealogy (IGG) was first introduced to criminal investigations in 2018, and it has since been used by U.S. law enforcement to help identify hundreds of criminal perpetrators and unidentified human remains. As expertise in IGG grows, policymakers have shown interest in regulating it. To help inform these efforts and to promote coherence in IGG governance as it expands, we recruited experts representing a spectrum of IGG-relevant professions and perspectives to identify and prioritize IGG practices for policy attention and to develop policy options for addressing them. In two rounds of a modified policy Delphi, …

The Abuse Of Neutrality, Rebecca Ingber

Articles

Neutrality law is a musty and obsolete body of international law that nevertheless rears its creaky head now and again in dangerous ways, most recently in the Russia-Ukraine conflict. The law of neutrality is a study in contradictions. It is obsolete yet remains on the books in treaties and military manuals. It purports to keep the peace and protect non-warring states yet today is invoked to expand conflict and protect aggressors. The legal benefits of neutrality have been entirely overtaken by other regimes. And yet neutrality law has not lost its luster despite losing its value. Instead of letting it …