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Articles 901 - 930 of 2638
Full-Text Articles in Medicine and Health
A Diagnostic Assessment Of The Health System's Response To Fgm/C Management And Prevention In Nigeria—Brief, Osasuyi Dirisu, Adetayo Adetunji, Mayokun Adediran, Otibho Obianwu
A Diagnostic Assessment Of The Health System's Response To Fgm/C Management And Prevention In Nigeria—Brief, Osasuyi Dirisu, Adetayo Adetunji, Mayokun Adediran, Otibho Obianwu
Reproductive Health
Globally, over 200 million women have been cut and are living with FGM/C-related consequences. In Africa, an estimated 27 million, 24 million, and 20 million girls/women have undergone FGM/C in Egypt, Ethiopia, and Nigeria respectively, the countries with the highest prevalence of FGM/C on the continent. In Nigeria, although the practice is considered widespread, national surveys suggest a gradual decline of FGM/C prevalence among women aged 15–49 years from 30 percent in 2008 to 20 percent in 2018. While these statistics suggest progress, the prevalence is still as high as 67 percent in some states. Nigeria’s National Strategic Health Development …
A Diagnostic Assessment Of The Health System's Response To Female Genital Mutilation/Cutting Management And Prevention In Kenya: A Case Study Of West Pokot County, Samuel Kimani
Reproductive Health
Female genital mutilation/cutting (FGM/C), a pervasive cultural practice in some contexts, is associated with negative impacts on women’s and girls’ health and rights. The health sector is well positioned to respond to the prevention of FGM/C and the management of its complications because of its primary role in disease prevention, health promotion, and curative services. In Kenya, the health sector’s role is anchored in national and county legal and policy instruments and guidelines that are adopted or customized from global or regional frameworks as well as skills support tools approved by the World Health Organization. This brief highlights findings from …
Improving The Documentation Of Female Genital Mutilation Or Cutting (Fgm/C) Abandonment Interventions And Their Evaluations, Caroline W. Kabiru
Improving The Documentation Of Female Genital Mutilation Or Cutting (Fgm/C) Abandonment Interventions And Their Evaluations, Caroline W. Kabiru
Reproductive Health
Female genital mutilation/cutting (FGM/C) is internationally recognized as a violation of human rights. Consequently, there have been extensive efforts to promote the abandonment of the practice. There is limited evidence on the impact of many of the efforts, in part because many interventions are implemented by small organizations with inadequate resources to document and evaluate their activities. The complex nature of FGM/C interventions, as with other interventions aimed at addressing violence against women and girls, also makes it difficult to adequately document what is done, how, when, and with what results. Nonetheless, it is important that implementing organizations make every …
Introduction Of Dmpa-Sc Self-Injection In Ghana: A Feasibility And Acceptability Study Using Sayana® Press, Dela Nai, Patrick Aboagye, Kamil Fuseini, Elizabeth Tobey, Aparna Jain, Nora Maresh, Rebecca Fertziger
Introduction Of Dmpa-Sc Self-Injection In Ghana: A Feasibility And Acceptability Study Using Sayana® Press, Dela Nai, Patrick Aboagye, Kamil Fuseini, Elizabeth Tobey, Aparna Jain, Nora Maresh, Rebecca Fertziger
Reproductive Health
This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among health-care providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health-care providers were trained to administer DMPA-SC and to train clients on self-injection. Clients assessed as being competent self-injected under the …
Reflections From Five Years Of Research On Fgm/C, Lori S. Ashford, Reshma Naik, Charlotte Greenbaum
Reflections From Five Years Of Research On Fgm/C, Lori S. Ashford, Reshma Naik, Charlotte Greenbaum
Reproductive Health
From 2015 to 2019, the Evidence to End FGM/C research consortium took a fresh approach to examining the longstanding practice of female genital mutilation/cutting (FGM/C). The African-led program developed innovative research methods and uncovered new evidence about the practice and how it is changing—focusing on families and communities, and health and legal systems. This report documents the consortium’s research methods, the key lessons learned, capacity strengthening efforts, enhanced advocacy for research uptake, and recommendations. The research sheds light on key areas for future investments that would ensure that FGM/C policies and programs are informed by rigorous evidence. The recommendations stem …
Understanding Local Variation In How Female Genital Mutilation/Cutting Declines, Changes, Or Persists: Analysis Of Household Survey Data For Kenya, Nigeria, And Senegal, Population Reference Bureau
Understanding Local Variation In How Female Genital Mutilation/Cutting Declines, Changes, Or Persists: Analysis Of Household Survey Data For Kenya, Nigeria, And Senegal, Population Reference Bureau
Reproductive Health
Efforts to eliminate female genital mutilation/cutting (FGM/C) intensified in many parts of Africa following a 2012 United Nations General Assembly Resolution, but change has been uneven. Important evidence gaps remain in our understanding of why the practice declines, changes, or persists in specific locations. Policymakers and program planners need such information to better tailor interventions to address local patterns and focus resources on abandonment efforts in areas with the greatest needs. To fill these gaps, researchers with the Evidence to End FGM/C consortium analyzed nationally representative household survey data for Kenya, Nigeria, and Senegal. The results of their research identify …
Female Genital Mutilation/Cutting In Nigeria: Is The Practice Declining? A Descriptive Analysis Of Successive Demographic And Health Surveys And Multiple Indicator Cluster Surveys (2003–2017), Ngianga-Bakwin Kandala, Glory Atilola, Chibuzor Christopher Nnanatu, Emmanuel Ogundimu, Lubanzadio Mavatikua, Paul Komba, Zhuzhi Moore, Dennis Matanda
Female Genital Mutilation/Cutting In Nigeria: Is The Practice Declining? A Descriptive Analysis Of Successive Demographic And Health Surveys And Multiple Indicator Cluster Surveys (2003–2017), Ngianga-Bakwin Kandala, Glory Atilola, Chibuzor Christopher Nnanatu, Emmanuel Ogundimu, Lubanzadio Mavatikua, Paul Komba, Zhuzhi Moore, Dennis Matanda
Reproductive Health
This report gives insight into the scale and scope of the practice of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years in Nigeria. It also presents evidence on where FGM/C occurs and highlights the dynamics of change as well as the context surrounding the practice. The report explores in detail the practice of FGM/C from all available sources of nationally representative survey data from 2003 to 2017 and the most relevant contextual information on key factors associated over time with FGM/C. The ultimate objective of the report is to generate evidence to inform …
Opioids In The Las Vegas Metro, Elia Del Carmen Solano-Patricio, Caitlin Saladino, William E. Brown
Opioids In The Las Vegas Metro, Elia Del Carmen Solano-Patricio, Caitlin Saladino, William E. Brown
Health
In 2014, Nevada was one of 7 states selected to participate in a national policy coalition to reduce prescription drug abuse. As a result, the Nevada Department of Health and Human Services (DHHS) and the Southern Nevada Health District (SNHD) created a data dashboard to track opioid prescriptions and opioid-involved overdose incidents. This Fact Sheet synthesizes state-level data from the Nevada Opioid Overdose Surveillance Dashboard and focuses on the Las Vegas Metropolitan Statistical Area (MSA). The data track opioid prescription rates as they correlate to opioid-involved overdose deaths, emergency room visits, and hospitalizations.
Opioids In Nevada, Peter Grema, Caitlin Saladino, William E. Brown
Opioids In Nevada, Peter Grema, Caitlin Saladino, William E. Brown
Health
This Fact Sheet presents data from the Washington Post’s Drug Enforcement Administration (DEA) database on opioid shipments in the United States and provides information pertaining to Nevada and each of its 17 regions (16 counties and one independent city). This Fact Sheet compares the Washington Post’s opioid shipment data with opioid prescription rates relative to Nevada’s population in 2010.
A Population-Based Investigation Of Health-Care Needs And Preferences In American Adults With Multiple Sclerosis, Chungyi Chiu, Malachy Bishop, Bradley Mcdaniels, Byung-Jin Kim, Lebogang Tiro
A Population-Based Investigation Of Health-Care Needs And Preferences In American Adults With Multiple Sclerosis, Chungyi Chiu, Malachy Bishop, Bradley Mcdaniels, Byung-Jin Kim, Lebogang Tiro
Early Childhood, Special Education, and Counselor Education Faculty Publications
Background: Comprehensive and effective multiple sclerosis (MS) health care requires understanding of patients’ needs, preferences, and priorities. Objective: To evaluate priorities of patients with MS for their MS care. Methods: Participants included 3003 Americans with MS recruited through the National MS Society and the North American Research Committee on Multiple Sclerosis patient registry. Participants completed a comprehensive questionnaire on aspects of their health-care experiences. Results: Participants identified the top 3 health-care priorities as (1) the affordability of MS health care, (2) ensuring that non-MS health-care providers have more education about MS and how it can interact with other conditions, and …
Breast Dressing: A Critical Review Of Post-Surgical Bras, Adi Sieradzki
Breast Dressing: A Critical Review Of Post-Surgical Bras, Adi Sieradzki
Dissertations, Theses, and Capstone Projects
Breast cancer is acknowledged in the United States as a phenomenon. With more than 3 million women either diagnosed or treated for it as of 2019, it is a seminal part of the American healthcare map. However, the market for the kinds of bras and bandages patients have to wear after surgery remains mostly overlooked and outdated. This thesis aims to explore what it means to bandage or dress a breast that has been altered either in combative or cosmetic procedures. Why post-surgical wound care for breasts still mostly looks like a sports bra? How do breast cancer patients rehabilitate …
Associations Between Female Genital Mutilation/Cutting And Early/Child Marriage: A Multi-Country Dhs/Mics Analysis, Jamlick Karumbi, David Gathara
Associations Between Female Genital Mutilation/Cutting And Early/Child Marriage: A Multi-Country Dhs/Mics Analysis, Jamlick Karumbi, David Gathara
Reproductive Health
Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through the combined efforts of international and nongovernmental organizations (NGOs), governments, and religious and civil society groups. Evidence of the wider impacts of FGM/C and interventions for its abandonment is small but emerging. The practice of FGM/C has frequently been linked to a girl’s marriageability and is thought to be associated with child marriage, either directly, as a cause of early/child marriage, or vice versa, or indirectly, resulting from common causes. Evidence of the relationships between these two practices to inform programming and policy for …
Modelling And Mapping Of Regional Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Senegal: Evidence From Senegal (Sdhs) Surveys 2005–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda
Modelling And Mapping Of Regional Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Senegal: Evidence From Senegal (Sdhs) Surveys 2005–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda
Reproductive Health
Between 2005 and 2017, Senegal experienced a slight national decline in the prevalence of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years. However, significant differences in prevalence exist as a result of multifarious risk factors. Our previous research in Senegal described the national trends in FGM/C, showing where, when, and why FGM/C is practiced in Senegal. However, no recent study exists to analyze the geographical patterns of FGM/C and the effect of individual-and community-level risk factors on the likelihood of cutting among girls younger than 15 years. This working paper presents results from …
Modelling And Mapping Of State Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Nigeria: Evidence From Dhs And Mics 2003–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda
Modelling And Mapping Of State Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Nigeria: Evidence From Dhs And Mics 2003–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda
Reproductive Health
The practice of female genital mutilation/cutting (FGM/C) has been positioned as a gender and global development issue that national and international organizations must address for girls and women to thrive in good health and enjoy their fundamental rights. Consequently, many efforts have been made to promote the abandonment of the practice. Despite evidence of a decline in FGM/C, there are significant variations in its prevalence in many sub-Saharan African countries, where the practice persists due to the combined effects of factors among individuals as well as communities. This working paper presents findings from a study that analyzed existing data using …
Prenatal Care For Undocumented Immigrants: Implications For Policy, Practice, And Ethics, Rachel Fabi
Prenatal Care For Undocumented Immigrants: Implications For Policy, Practice, And Ethics, Rachel Fabi
Population Health Research Brief Series
Nearly 250,000 babies are born each year to undocumented immigrant parents in the U.S. These babies are U.S. citizens, but undocumented immigrants are ineligible for most public insurance, making it difficult for them to access prenatal care. This research brief describes restrictive policies related to prenatal care for undocumented immigrants and discusses how these policies affect health care providers and the care they are able to offer pregnant immigrant women.
Avoiding Over-Diagnosis: Exploring The Role Of Gender In Changes Over Time In Statistics Anxiety And Attitudes, Kelly Rhea Macarthur
Avoiding Over-Diagnosis: Exploring The Role Of Gender In Changes Over Time In Statistics Anxiety And Attitudes, Kelly Rhea Macarthur
Numeracy
The importance of quantitative literacy for creating and maintaining a democratic and just society is unequivocal, but undergraduate students often do not acquire these important skills. One barrier to teaching quantitative literacy skills is students’ anxiety. The empirical evidence of the extent of the problem, however, does not seem to match anecdotal accounts of instructors who may be “diagnosing” statistics anxiety as universal among students and across different sources of anxiety. The purpose of this study is to identify the specific aspects of statistics anxiety that present barriers to student success by employing the Statistics Anxiety Rating Scale (STARS) to …
Effects Of Quantitative Literacy On Healthcare Decision-Making: An Aural Context, Robert G. Root, Sonia Bhala
Effects Of Quantitative Literacy On Healthcare Decision-Making: An Aural Context, Robert G. Root, Sonia Bhala
Numeracy
We propose a relationship between sensory modality, numerical formatting, and performance on a survey simulating healthcare decision-making. We examine the current literature on aural health literacy, and specifically aural literacy coupled with health numeracy. We then create a survey instrument called the Bhala test for this purpose and demonstrate that it is moderately internally consistent and provides results that correlate with the NUMi assessment, a widely accepted measure of health numeracy. The quantitative information provided in the Bhala test has two treatments, percentage and natural frequency formats, in an effort to determine which format is easier for subjects to use …
Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea
Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea
Poverty, Gender, and Youth
This Population Council Annual Evaluation Report includes evaluation activities from December 1, 2015 to December 1, 2019, and future evaluation plans (2019–21), as part of the Opening Futures (Abriendo Futuros) project for indigenous girls in Yucatan, Mexico. The first section describes the finalized analysis of the impact evaluation of the pilot phase; the second section reports the progress of evaluation activities; and the third section includes an evaluation of future plans for the period December 1, 2019 to November 30, 2021.
Temple Stay As Transformative Travel: An Experience Of The Buddhist Temple Stay Program In Korea, Susan L. Ross, Jungyun (Christine) Hur, Jamie Hoffman
Temple Stay As Transformative Travel: An Experience Of The Buddhist Temple Stay Program In Korea, Susan L. Ross, Jungyun (Christine) Hur, Jamie Hoffman
Journal of Tourism Insights
The burgeoning tourism niche called temple stay, which originated in Korea, has been marketed to Koreans and internationals as a means for travelers to become immersed in cultural heritage, learn about Buddhism, and find one’s “true self” by spending a few days to a week as a guest in a living, operational Buddhist monastery. Although this tourism segment is gaining wide-spread appeal, the temple stay phenomenon has received relatively little scholarly attention outside of Korea. The handful of papers identified on the subject that are written in English, refer to this phenomenon as constituting various segments such as rural tourism, …
Leveraging The Power Of Mutual Aid, Coalitions, Leadership, And Advocacy During Covid-19, Daniela Domínguez, Dellanira García, David A. Martínez, Belinda Hernandez-Arriaga
Leveraging The Power Of Mutual Aid, Coalitions, Leadership, And Advocacy During Covid-19, Daniela Domínguez, Dellanira García, David A. Martínez, Belinda Hernandez-Arriaga
Psychology
The COVID-19 pandemic has shed light on the norms, patterns, and power structures in the United States that privilege certain groups of people over others. This manuscript describes COVID-19 as an unprecedented catalyst for social transformation that underscores the need for multi-level and cross-sectoral solutions to address systemic changes to improve health equity for all. The authors propose that the American Psychological Association and its membership can initiate systemic change, in part, by: (a) supporting mutual aid organizations that prioritize the needs of vulnerable communities; (b) leveraging the efforts and strides APA psychologists have already made within the association, in …
Why Sharp, Bureau Of Sociological Research
Why Sharp, Bureau Of Sociological Research
Nebraska Student Health and Risk Prevention Surveillance System (SHARP)
The Value of SHARP: The administrations of the Youth Risk Behavior Survey (YRBS), Youth Tobacco Survey (YTS), and Nebraska Risk and Protective Factor Student Survey (NRPFSS) were combined in 2010 to make up the Student Health and Risk Prevention (SHARP) Surveillance System. SHARP is the umbrella encompassing the ONLY three student health surveys endorsed by the Nebraska Department of Education (NDE) and Nebraska Department of Health and Human Services (NDHHS).
The Power of Data
How the SHARP data is used by stakeholders
Why schools In Your Area Should Participate
Patient Advocacy: A Tool For Resolving Ethical Issues For Patients That Use The Emergency Department For Chronic Care Management, Lawanda Baskin
Patient Advocacy: A Tool For Resolving Ethical Issues For Patients That Use The Emergency Department For Chronic Care Management, Lawanda Baskin
Journal of Health Ethics
The current state of scientific knowledge on using the emergency department (ED) for chronic care management indicates that using the ED for chronic care management creates health disparities and burdens healthcare systems. Ethical concerns also arise because patients use the ED for chronic care management. This article discusses health literacy, self-care behaviors, and social support and the presence of patient suffering, nonmaleficence, and beneficence in patients who seek care for chronic care management in the ED. Patient advocacy as a tool to lessen these ethical issues is further discussed. Eighty-six participants were used in a cross-sectional correlational predictive study. Findings …
Why Sharp (Summary Sheet For Schools), Bureau Of Sociological Research
Why Sharp (Summary Sheet For Schools), Bureau Of Sociological Research
Nebraska Student Health and Risk Prevention Surveillance System (SHARP)
The Value of SHARP
The Power of Data: Your school can receive school and local level results from the NRPFSS, along with state wide results from the YRBS and YTS. The comparison of local and state data is what makes the SHARP surveys so significant. The results of these surveys will not only affect your school and your students, but your community as a whole. The data collected are used by community, regional, and state level groups, including the NDE and NDHHS, to identify areas needing improvement and to track the effectiveness of their efforts. This information also helps schools …
Social Stigma, Public Health, And Addiction In Albania, Ediola Malkouari
Social Stigma, Public Health, And Addiction In Albania, Ediola Malkouari
Honors Undergraduate Theses
Drug use is considered in many countries the plague of today's society. Researchers from medical, psychological and sociological fields, as well as lawmakers, are interested in finding more answers to this widespread phenomenon. All over the world there are known conflicts related to drug producing, transportation routes and distribution, that harm the economy and social standing of the involved communities or countries. Policies towards drug use vary from country to country, but this research focuses on how stigma affects the lives of individuals suffering from substance use disorder (SUD) in Albania. Substance use disorder is not often considered a disease, …
How Race, Socioeconomic Status, And Gender Shape Feelings Of Competition Within The Pre-Med Department At A Small Liberal Arts College, Amanda B. Deming
How Race, Socioeconomic Status, And Gender Shape Feelings Of Competition Within The Pre-Med Department At A Small Liberal Arts College, Amanda B. Deming
Honors Theses
This study aims to understand how students of color navigate feelings of competition in the pre-medical (“pre-med”) track at a small liberal arts college. I argue that there are differences in navigational strategies by race, socioeconomic status (SES), and gender. Respondents in my sample (9 women and 6 men) were interviewed for 30 to 60 minutes about their relationships with fellow pre-med students, mentors, alumni, advisors, and professors. The primary findings of this project were that students who are more competitive dominate the culture among pre-med students; less competitive individuals persist through the pre-med track by forming study groups with …
Tobacco Use Disparities By Sexual And Gender Minority Status Among Ucf Students., Parth N. Patel
Tobacco Use Disparities By Sexual And Gender Minority Status Among Ucf Students., Parth N. Patel
Digital Repository: Showcase of Undergraduate Research Excellence
No abstract provided.
The Positive Effects Of Exercise On Active Transplant Recipients And Its Impact On Medication Adherence, Travane Morrison
The Positive Effects Of Exercise On Active Transplant Recipients And Its Impact On Medication Adherence, Travane Morrison
Theses
Organ failure is a life-threatening condition (Daugirdas et al, 2014). Non-adherence to medication is one of the main causes of the failure of a transplanted organ (Oberlin et al, 2016). In an effort to combat non-adherence to medication, research had employed intervention studies to tackle the main cause of non-adherence (Chisholm-Burns, 2013). The aims of this project are three fold. Firstly it aims to find if complications associated with organ transplant affect the individual’s medication adherence. Secondly, it explores the connections between exercise and medication adherence. Thirdly the research explores if exercise assists with possible complications associated with an organ …
The Path To Pregnancy: Fertility Services And Assisted Reproductive Technologies, Olivia H. Gilbert
The Path To Pregnancy: Fertility Services And Assisted Reproductive Technologies, Olivia H. Gilbert
Scripps Senior Theses
The emergence of reproductive assistance like fertility treatments and assisted reproductive technologies (ART) in recent decades have provided new paths to pregnancy for many individuals. However, certain demographics in the US like low-income women and women of color are often excluded from utilizing these services on the basis of race, geography, and socioeconomic status. This in turn leads to significant disparities in access to and usage rates of such services. This research points out the perceived shortcomings in the current academic discussion surrounding fertility service disparities with the ultimate goal of expanding access to fertility assistance services for those who …
Vulvodynia, It’S In My Head: Mad Methods Toward Crip Coalition, Renee Dumaresque
Vulvodynia, It’S In My Head: Mad Methods Toward Crip Coalition, Renee Dumaresque
Journal of Feminist Scholarship
This article employs a mad transdisciplinary approach to autoethnography to detail vulvodynia — or chronic vulvar pain — within the system of (dis)ability. Through autoethnography, the self operates as a mobile orientation from which to identify and disrupt the colonial rationalities that differentially construct and narrate vulvodynia across sites of madness and disability. Through historical, discursive, and autoethnographic analysis, I locate vulvodynia’s role in various processes of subject, race, and settler-state formation from the nineteenth century up to the neoliberal present.
Physical Activity In Two Low-Income Detroit Neighborhoods: Disentangling Human Agency From Social Structure, Daniel J. Rose
Physical Activity In Two Low-Income Detroit Neighborhoods: Disentangling Human Agency From Social Structure, Daniel J. Rose
The Journal of Sociology & Social Welfare
This article explores strategies developed by African American residents in response to barriers to physical activity in two low-income Detroit neighborhoods. Using 47 in-depth, qualitative interviews, a grounded theory approach allowed the analysis to be reframed around the ways in which structural factors conditioned, but did not determine the human agency of residents seeking physical activity. Interviews revealed numerous responses to structural barriers such as devising home routines, cognitive mapping to avoid perceived threats, and leaving the neighborhood to access resources. Differences in neighborhood contexts, along with unique individual concerns, showed that agency was neither a constant nor independent force, …