Health Policy Commons^™

Call For Moral Recognition As Part Of Paediatric Assent, Jared Smith, Jennifer Blumenthal-Barby

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

Withdrawing Extra Corporeal Membrane Oxygenation (Ecmo) Against A Family’S Wishes: Three Permissible Scenarios, Trevor M Bibler, Asma Zainab

Center for Medical Ethics and Health Policy Staff Publications

The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient's legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the …

Cancerhervdb: Human Endogenous Retrovirus (Herv) Expression Database For Human Cancer Accelerates Studies Of The Retrovirome And Predictions For Herv-Based Therapies, Erik Stricker, Erin C Peckham-Gregory, Michael E Scheurer

Center for Medical Ethics and Health Policy Staff Publications

In this study, we sought to create a database summarizing the expression of human endogenous retroviruses (HERVs) in various human cancers. HERVs are suitable therapeutic targets due to their abundance in the human genome, overexpression in various malignancies, and involvement in various cancer pathways. We identified articles on HERVs from PubMed and then prescreened and automatically categorized them using the portable document format (PDF) data extractor (PDE) R package. We discovered 196 primary research articles with HERV expression data from cancer tissues or cancer cell lines. HERV RNA and protein expression was reported in brain, breast, cervical, colorectal, endocrine, gastrointestinal, …

Use Of Advance Directives In Us Veterans And Non-Veterans: Findings From The Decedents Of The Health And Retirement Study 1992–2014, Ho-Jui Tung, Ming-Chin Yeh

Health Policy & Community Health: Faculty Publications

Evidence shows that older patients with advance directives such as a living will, or durable power of attorney for healthcare, are more likely to receive care consistent with their preferences at the end of life. Less is known about the use of advance directives between veteran and non-veteran older Americans. Using data from the decedents of a longitudinal survey, we explore whether there is a difference in having an established advance directive between the veteran and non-veteran decedents. Data were taken from the Harmonized End of Life data sets, a linked collection of variables derived from the Health and Retirement …

An Integrated Isothermal Nucleic Acid Amplification Test To Detect Hpv16 And Hpv18 Dna In Resource-Limited Settings, Kathryn A Kundrod, Maria Barra, Alexis Wilkinson, Chelsey A Smith, Mary E Natoli, Megan M Chang, Jackson B Coole, Akshaya Santhanaraj, Cesaltina Lorenzoni, Celda Mavume, Hira Atif, Jane Richards Montealegre, Michael E Scheurer, Philip E Castle, Kathleen M Schmeler, Rebecca R Richards-Kortum

Center for Medical Ethics and Health Policy Staff Publications

High-risk human papillomavirus (HPV) DNA testing is widely acknowledged as the most sensitive cervical cancer screening method but has limited availability in resource-limited settings, where the burden of cervical cancer is highest. Recently, HPV DNA tests have been developed for use in resource-limited settings, but they remain too costly for widespread use and require instruments that are often limited to centralized laboratories. To help meet the global need for low-cost cervical cancer screening, we developed a prototype, sample-to-answer, point-of-care test for HPV16 and HPV18 DNA. Our test relies on isothermal DNA amplification and lateral flow detection, two technologies that reduce …

Historical Trauma: Literary And Testimonial Responses To Hiroshima, Mariam Ghonim

Theses and Dissertations

The concept of trauma is controversial in literature. While one may be able to come up with ways to describe trauma in fiction, representing historical trauma is a hard task for writers. Some argue that trauma can not be described through those who did not experience it, while others claim that, provided some elements are added, one can represent trauma to the reader. This thesis focuses on twentieth-century historical traumas related to a nuclear catastrophe and explores the different literary and testimonial responses to the catastrophic man-made event of Hiroshima (1945). In this thesis, Kathleen Burkinshaw’s historical fiction The Last …

Cervical Cancer Screening Among English- And Spanish-Speaking Hispanic Women In An Urban Safety Net Health System, 2015–2020, Trisha L Amboree, Susan Lackey Parker, Shaun Bulsara, Matthew L Anderson, Kathleen M Schmeler, Elizabeth Y Chiao, Jane R Montealegre

Center for Medical Ethics and Health Policy Staff Publications

Background: The Hispanic population is heterogeneous with differences in health behaviors across subgroups by nativity and preferred language. We evaluated cervical cancer screening adherence among English- and Spanish-speaking Hispanic patients receiving care at a safety net health system.

Methods: Electronic health records were used to identify 46,094 women aged 30-65. Up to date (UTD) screening was defined based on date of last Pap test, human papillomavirus (HPV) test, or Pap/HPV co-test.

Results: Overall, 81.5% of 31,297 Hispanic women were UTD. English-speaking Hispanic women had a lower prevalence of being UTD when compared to Spanish-speaking Hispanic women (aPR: 0.94, 95% CI: …

“Handicap Removed”: An Alternative Path To The Social Model, Craig M. Rustici

Journal of Gender, Ethnic, and Cross-Cultural Studies

This article identifies an expression of a social model of disability in a 1966 film promoting Hofstra University’s Program for the Higher Education of the Handicapped and traces that model back to books published by the pioneering rehabilitation physician Henry H. Kessler in 1935 and 1947, decades before the UPIAS (Union of the Physically Impaired against Segregation) Fundamental Principles of Disability (1976). In light of Kessler’s articulation of social and minority models, identification of contrasting religious, charity and medical models, and discussion of disability stigma, this article reassesses Ruth O’Brien’s critique, in Crippled Justice (2001), of Kessler and the twentieth-century …

The Herlyn-Werner-Wunderlich (Hww) Syndrome– A Rare Case Report, Dr Harisha H L Dr, Dr Vishal Natarajan Dr, Dr Rudresh Hiremath Dr

Radiology Teaching Files

A 20-year-old unmarried female, student by occupation, well built and nourished presented with intermenstrual spotting from past 1 month. No h/o pelvic pain/ mass/ fever. No h/o of similar complaints in the past. Attained menarche at 14 years. Menstrual history otherwise normal.Known case of right renal agenesis (diagnosed incidentally at the age of 8 years).

Pelvic examination by gynecologist revealed a cystic bulge to the anterior wall of vagina. On MRI, our case is right sided renal agenesis; uterus didelphys with obstructed hemi vagina and to infected collection along the vaginal wall.

Recovery Journey Of Diverse Populations Using Design Thinking Method: Recommendations For Practitioners And Policymakers, Lawrence Bryant, Monica Nandan, Sherrie Cade, Bianca Anderson

Journal of Social, Behavioral, and Health Sciences

Through a state grant-funded multicultural needs assessment, researchers from a U.S. southeastern state university captured the voices of underserved populations related to their unmet needs and recovery journey from the non-medical use of opioids and other substances. Specific voices of African Americans, Latinx, mature adults, veterans, people who are homeless, college students, and individuals within the lesbian, gay, bisexual, trans, and queer (LGBTQ+) communities were captured utilizing design thinking protocol in focus groups. Participants recommended that providers be culturally responsive in disseminating information and providing affirming care. Moreover, participants felt that counselors and other professionals should be more empathetic and …

Humanity In Trauma, Alyssa K. Thompson

University Honors Theses

The main objective of the literature review is to use the trauma-informed care paradigm to argue that the current implementation of trauma-informed care reinforces hierarchies of harm, leading to feelings of moral obligation and moral injury while perpetuating othering. This literature review criticizes trauma-informed care, emphasizing lived experiences against the characteristics trauma-informed care aspires to reflect. The review centers on the broad themes of understanding, universality, and acceptance of the present trauma-informed care paradigm. The critique comes from the silently excluded group of healthcare workers, with a personal perspective from a professional who worked in an urban hospital emergency department …

Using Infectious Disease Simulations To Model, Quantify, And Predict The Impact Of Self-Quarantine And Vaccination On Mpox Spread Across The United States, Amar Johanna Scherzer

Quantitative Social Science Undergraduate Senior Theses

In this paper, I build a data-driven theoretical model that reproduces the epidemiological (epi) curve of the mpox outbreak in the United States. The general framework presented in this paper considers the susceptible (S), infected (I), and recovered (R) stages of an mpox infection through an SIR model of disease spread. I use vaccination, transmissibility, recovery, and self isolation rates as parameters in my SIR model as well as a lag-time to account for the delay in vaccination roll-out. By using real-world data to inform estimates of the susceptible population and mpox transmission characteristics, I am able to simulate an …

Evaluation Of Feasibility And Acceptability Of A Web-Based Diabetes Prevention Program (Dpp) For Diabetes Risk Reduction In Chinese Americans In New York City, Ming-Chin Yeh, Wincy Lau, Claire Anselmo Keady, Margrethe Horlyck-Romanovsky, Ho-Jui Tung, Lu Hu, Grace X. Ma, Judith Wylie-Rosett

Health Policy & Community Health: Faculty Publications

Introduction: Intensive lifestyle intervention remains an effective modality to reduce diabetes incidence and delay the progression to type 2 diabetes. The primary aim of this study was to pilot-test the feasibility and acceptability of a culturally and linguistically tailored web-based DPP intervention among Chinese Americans with prediabetes living in New York City.

Methods: Thirteen Chinese American participants with prediabetes were recruited to complete a 1-year web-based Diabetes Prevention Program (DPP) lifestyle intervention. Quantitative and qualitative measures such as retention rate and data collected from web-based questionnaires and focus groups were collected and analyzed to assess study feasibility and …

Modeling The Longitudinal Changes Of Ancestry Diversity In The Million Veteran Program, Frank R Wendt, Gita A Pathak, Jacqueline Vahey, Xuejun Qin, Dora Koller, Brenda Cabrera-Mendoza, Angela Haeny, Kelly M Harrington, Nallakkandi Rajeevan, Linh M Duong, Daniel F Levey, Flavio De Angelis, Antonella De Lillo, Tim B Bigdeli, Saiju Pyarajan, John Michael Gaziano, Joel Gelernter, Mihaela Aslan, Dawn Provenzale, Drew A Helmer, Elizabeth R Hauser, Renato Polimanti, Department Of Veteran Affairs Cooperative Study Program (#2006)

Center for Medical Ethics and Health Policy Staff Publications

Background: The Million Veteran Program (MVP) participants represent 100 years of US history, including significant social and demographic changes over time. Our study assessed two aspects of the MVP: (i) longitudinal changes in population diversity and (ii) how these changes can be accounted for in genome-wide association studies (GWAS). To investigate these aspects, we divided MVP participants into five birth cohorts (N-range = 123,888 [born from 1943 to 1947] to 136,699 [born from 1948 to 1953]).

Results: Ancestry groups were defined by (i) HARE (harmonized ancestry and race/ethnicity) and (ii) a random-forest clustering approach using the 1000 Genomes Project and …

Gender And Disability: An Exploration Of Reflective Practice For Protection And Access Amid Complex Emergencies, Lindsey A. Mandolini

Electronic Theses and Dissertations

Gender and Disability: An Exploration of Reflective Practice for Protection and Access Amid Complex Emergencies is a qualitative research project exploring under what conditions and in what ways disabled persons’ organizations (DPOs) effectively protect and provide access to women and girls with disabilities amid complex emergencies. The study upheld a participatory approach and rights-based framework, emphasizing that authentic inclusion requires centering disabled voices in research. Drawing on extant research, grey literature, and data collected from online practitioner questionnaires and semi-structured interviews, the study conducted a multi-phased reflexive thematic analysis. The research findings culminate in a composite narrative that brings to …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Expanding Narrative Medicine Through The Collaborative Construction And Compelling Performance Of Stories, Woods Nash, Mgbechi Erondu, Andrew Childress

Center for Medical Ethics and Health Policy Staff Publications

This essay proposes an expansion of the concept of narrative competence, beyond close reading, to include two more skills: the collaborative construction and compelling performance of stories. To show how this enhanced form of narrative competence can be attained, the essay describes Off Script, a cocurricular medical storytelling program with three phases: 1) creative writing workshop, 2) dress rehearsal, and 3) public performance of stories. In these phases, Off Script combines literary studies, creative writing, reflective practice, collegial feedback, and drama. With increased narrative competence, Off Script participants are likely better equipped to engage in more impactful health advocacy and …

Conservative And Cultural Clashes With Comprehensive Sexuality Education, Bryan Z. Anderson

Dissertations, Theses, and Capstone Projects

This thesis analyzes the multifaceted debate over the use of comprehensive sexuality education (CSE) in United States public schools, while also emphasizing the ways in which withholding CSE is a strategy to uphold the white supremacist patriarchy. The work begins by historically framing the evolution of sexuality education through the United States’ history. This leads to the current discourse around CSE and the ways in which it is the optimal support for American youth today. After setting this foundation, the thesis looks at conservative figures and groups who are seeking to prevent public school adoption of CSE standards, as well …

Correction To: Black Bioethics In The Age Of Black Lives Matter, Keisha Ray, Faith E Fletcher, Daphne O Martschenko, Jennifer E James

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

Divergent Clinical Presentations And Outcomes Among Children And Adolescents With Kaposi Sarcoma In Malawi And Tanzania, Liane R Campbell, Allison Silverstein, Erin Peckham-Gregory, William Kamiyango, Jimmy Villiera, Casey L Mcatee, Jason M Bacha, Carrie L Kovarik, Parth S Mehta, Toni Chanroo, Asulwisye Kapesa, Beatrice Malingoti, Rizine Mzikamanda, Nmazuo W Ozuah, Carl E Allen, Michael E Scheurer, Nader K El-Mallawany

Center for Medical Ethics and Health Policy Staff Publications

Objectives: The Kaposi sarcoma (KS) T0 versus T1 staging classification does not address the unique clinical features of paediatric KS in human gammaherpesvirus 8 (HHV-8) endemic regions of Africa. This study seeks to define patterns of childhood KS using a paediatric-specific approach.

Methods: The Lilongwe paediatric KS staging classification categorizes disease based on clinical phenotype: stage 1 = mild/moderate KS limited to cutaneous/oral involvement, stage 2 = primarily lymphadenopathic disease, stage 3 = woody edema KS, stage 4 = visceral and/or severe/disseminated mucocutaneous disease. Characteristics and outcomes were evaluated from paediatric referral centres in Lilongwe, Malawi, and Mbeya, Tanzania.

Results: …