In 2023, medication for opioid use disorder (MOUD), including methadone and buprenorphine, remains the most effective intervention for preventing overdose death among people who consume opioids. Yet, among those seeking treatment for opioid use disorder (OUD), there are disparities in access, quality of care, and treatment outcomes. Those disparities are related to attributes of people who use opioids, the circumstances of use, the nature of opioid use as a disease, and the design of services to treat the disease. The complex relationships between these attributes are not well articulated or understood. Health services research recognizes the biopsychosocial nature of the health conditions but research to improve treatment for OUD calls for a comprehensive, integrative, transdisciplinary approach. This dissertation presents such an approach by focusing on the biological and psychosocial implications of trauma and traumatic stress disorders in the etiology, presentation, and treatment of OUD. Aim 1 was to leverage a preclinical animal model in neuroscience to investigate how a fear memory cue may trigger recurrence of drug-seeking. Aim 2 was to examine how primary care clinicians incorporate principles of Trauma-Informed Care into OUD treatment based on qualitative interview accounts of their practices. Aim 3 was to leverage a longitudinal retrospective analysis of linked medical records and claims data to estimate the effect of post-traumatic stress disorder (PTSD) diagnosis on health services utilization and explores effect moderation by race and gender. The findings from the three studies inform each other, and the dissertation helps to clarify the significance of trauma in effectively and equitably serving people with OUD. Theoretically, the dissertation incorporates the tenets of Nancy Krieger’s Ecosocial Theory in its explication of OUD treatment. Ecosocial theory builds on the biopsychosocial approach in its inclusion of societal arrangements of power and structural oppression as shaping the pathways of embodiment. Many people with OUD incorporate lived experience of trauma. Utilization of formal OUD treatment settings can shape pathways of embodiment and may be yet another adverse exposure. The socially produced determinants of traumatic stress disorders and associated OUD should encourage health scientists to think critically and systematically about the connections between our biological, social, and psychological existence to be able to effectively respond to OUD as a complex biopsychosocial phenomenon. / 2025-08-23T00:00:00Z

Smartphone technology has transformed the process by which women understand themselves, manage their care decisions and access health information, while also creating a space for more integrated and individualized understandings of wellness. Using exploratory, semi-structured interviews (n = 27) and observation of phone use, this study examines how minority women in Boston engage with smartphones through health-related mobile applications and web searches. Drawing upon postphenomenology, I examine the way smartphones have become both a regulatory force and motivational tool in the formation of self. I argue that the integration of smartphones into user identity positions them as the primary entryway for health decision-making (Garro, 1986, 1998) and patient-clinician interactions.

INTRODUCTION: Inefficiencies in health systems waste resources and reduce quality of care. At Dana Farber Cancer Institute, the majority of patient complaints centered around wait times often due to suboptimal workflows. To reduce infusion wait time (IWT), three initiatives were piloted on one outpatient clinic floor: 1) premixing qualified chemotherapy drugs during off-peak hours of day, 2) sharing late sign data with providers to encourage them to sign medication orders as soon as patients were seen in exam, and 3) moving a pharmacist physically closer to providers on the exam side to support the medication verification process. The goal of this study was to evaluate the three improvement initiatives and assess their impact on IWT. METHODS AND MATERIALS: The baseline period was September–December 2017 and the implementation period was January–September 2018. The three initiatives were implemented in a staggered fashion within the implementation period. IWT was defined as the later of infusion appointment or check-in time to first infusion medication administration time, and the 75th percentile was used to monitor change. Process metrics were also defined and monitored for each improvement initiative. A unique SQL code was written to pull and merge data tables from the electronic medical record (Epic) and real-time locating system (RTLS). Tableau and SAS were used to clean, analyze, and visualize time series data. RESULTS: The 75th percentile IWT decreased from baseline 80 minutes to 68 minutes once all three initiatives were implemented. Moving the pharmacist closer to the exam side where providers signed their medication orders shortened the 75th percentile medication order verification time by 15 minutes (38% reduction) for the gynecology cancer group. Provider late order signing percentages also significantly decreased from 24% to 13%. A higher percentage of qualified premix orders were prepared during off-peak hours (from 78% to 91%) and before the infusion appointment time (from 43% to 87%). Feedback from frontline staff regarding the initiatives were extremely positive. CONCLUSION: Reducing chemotherapy infusion wait time is possible at a comprehensive cancer center. More efficient workflows can translate to patient satisfaction, reduce cost, and improve the quality of care. / 2021-08-29T00:00:00Z

Implantable medical devices (IMDs) have advanced significantly in the last few decades due to innovations in microelectronics and power sources. Today, IMDs can perform various vital functions such as stimulating muscular organs (e.g., heart, bladder, neurons) to maintain the body mechanics and regulating physiological fluid (e.g., blood, hormone, urine, etc.). All of these effectively improve the quality of life and prolong life expectancy. However, many existing IMDs often blindly deliver therapeutic means without knowing the state of the disease. Since IMDs are usually surgically introduced to the human body, post-operation adjustments are difficult, resulting in chronic stimulation. As such, the long-term operation of IMDs shall be precisely regulated based on the current state of the body, i.e., closing the loop, especially with unprecedented communication and powering techniques. The goal of this research is to develop an implantable medical device (IMD) platform that can close the loop not only between sensing and stimulation within the IMD itself but also between other IMDs and the outside world. Thus, we first demonstrate a standalone closed-looped IMD that regulates oxygen generation based on physiological levels. Second, the IMD platform can also bridge other passive implantable sensors to the outside world. To this end, this report discusses a passive sensor in the form of a Smart Stent that senses and transmits arterial blood pressure information to the IMD platform via magnetic resonance (MR) coupling. Therefore, such MR coupling intrabody communication in the body is rigorously investigated. Lastly, we report an effective and efficient powering technique for the IMD platform. Ultrasonic waves in the human body can travel long distances with relatively low attenuation, reaching deep tissue. In this thesis, we enhance the ultrasonic powering method for IMDs with a novel receiver design for omnidirectional powering. Overall, the proposed multifunctional, multimodal, wireless IMD platform can operate reliably for the long term due to novel MR coupling communication and omnidirectional ultrasonic powering. / Electrical and Computer Engineering

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