MPM / Oliver Tambo Institute of Governance and Policy Studies

In these current times of the COVID-19 pandemic, the need for a widely available diagnostic platform for diagnosis of viral infections cannot be overstated. Such a platform that can be easily manufactured on a large scale would be beneficial both for making clinical decisions as well as provide new tools to epidemiologists broadly screening the population during epidemic threats. Fraunhofer USA CMI has focused on manufacturability of point-of-care (POC) diagnostics as a strategic point of development that can reduce costs and close the gap between research efforts and getting devices to the market. Here we report an inkjet printed platform that has the potential to increase the sensitivity of the molecular assay, be compatible with mass manufacturing methods and allow for reagent storage on-chip. Isothermal methods such as loop-mediated isothermal amplification (LAMP) have been used for rapid disease diagnosis in low resource settings due to their increased sensitivity and lack of thermal cycling. Fluorescent based LAMP readout techniques like QUASR also lend themselves to easy deployment in field settings via smartphones. However, rather than taking the standard approach, we developed a hydrogel based LAMP (gel-RTLAMP) assay by incorporating an engineered hydrogel, highly methacrylated gelatin (GM10). In this study we show that this hydrogel is compatible with both the LAMP reaction and piezoelectric inkjet printing. Furthermore, via limit of detection studies we also show that this gel-RTLAMP assay is 100 fold more sensitive than a standard RT-LAMP assay and results in clinically relevant detection of DENV RNA in analytical samples (10 copies per reaction). Unfortunately we could not characterize the final inkjet printed platform due to time limitations and other issues, but instead we report a proof-of-principle study to show that this gel-RTLAMP assay can be adapted in a microarray format via inkjet printing and has the potential for rapid multiplexing and digitization of the assay.

A lack of contraception use and contraceptive method discontinuation are common causes of unintended pregnancy in the Eastern Cape. The most common reason for method discontinuation among childbearing women is the unacceptable side effects of their contraceptive choices. Both depression and sexual dysfunction are given as side effects of contraceptive use; however, there is little evidence to support these effects. This randomised, single-blind controlled trial conducted in East London, South Africa, Investigated the effects of the initiation of a long-acting injectable contraceptive, Depot Medroxyprogesterone Acetate (DMP A), compared with the initiation of a copper Intrauterine Contraceptive Device (Cu-IUD) after childbirth on depression and sexual functioning. After counselling, 242consenting pregnant women were randomised to receive DMP A or a Cu IUD within 48 hours of childbirth, in a ratio of 1:1. Primary outcome measures were depression and sexual dysfunction evaluated by validated instruments. Questionnaires were administered at baseline, and telephonically at one month and three months after randomisation. The telephonic interviewer was blinded to the participants' group allocation. English and Xhosa versions of the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale were used to assess depression. The Arizona Sexual Functioning Scale was used to assess sexual functioning. For these primary outcomes, median scores between the intervention groups were compared, as well as the number of events (dichotomous data) in each intervention group. There relative effects of these interventions were summarised by calculating risk ratios, with 95% confidence intervals. Statistical tests used included the Shapiro-Wilk test, T-test, and Wilcoxon test. There were not consistently statistically significant differences in the risk of depression or sexual dysfunction between the intervention groups in this study. However, there was a trend towards more depression in the DMPA group which was statistically significant for mean EPDS score at the one month and for the BDI score three month assessments compared with the IUD group. There was also a trend to more sexual dysfunction with DMPA, but the only statistically significant difference was that fewer women in the DMPA group resumed sexual intercourse within the first month of treatment than in the IUD group. The author's recommendations from the study are that, firstly, family planning providers should inform women during contraceptive counselling that there is no certainty that DMPA causes depression and/or sexual dysfunction; however, it may do so in the postpartum period. Secondly, contraceptive users can continue to use DMPA with confidence as a convenient and effective method of preventing unintended pregnancy. Thirdly, the trend towards postpartum depression and sexual dysfunction in the DMPA group of this study justifies further research with a larger sample size, to include women from various social settings, and for a longer period of follow-up. Lastly, the Cu-IUD is a good alternative to DMPA in women who experience intolerable effects with the latter.

This research examines the healthcare services ecosystem and the impact and role service interventions made by providers and patients have on this ecosystem. Each area has an important role in contributing to the value and sustainability of the ecosystem. Healthcare, as a community service, requires a minimum of two counterparts: the providers and the customers, in this case the patients. Healthcare is a unique ecosystem because often the customers are not conscious of the interplay of the ecosystem but are reliant upon the system for their health and wellbeing. The first section of this dissertation examines the effects that occur in the healthcare ecosystem when part of the system experiences a disaster and the impact and role of other areas of the system in response to the disaster, particularly regarding the resilience. Similar to a biological ecosystem that is undergoing a flood, in the healthcare services ecosystem if too many patients present to the Emergency Department (ED) at the same time disaster level overcrowding will occur. We aim to measure the resilience of the healthcare ecosystem to this disaster level overcrowding. The second section of this dissertation examines how the components of the healthcare ecosystem maintain sustainability and usability. Healthcare professionals are assessed regarding their ability to maintain the healthcare ecosystem, with a specific focus on what occurs after patients are in the hospital system. To examine the ability of the healthcare professionals to maintain the ecosystem we analyze the usability and adaptability of the electronic health record and the professional's workflows to determine how they use this tool to sustain the healthcare ecosystem. The third section of this dissertation examines patient self-management and the influence this has on the healthcare ecosystem. Much of the management of health in patients, particularly those with chronic illnesses, occurs outside of the hospital, thus examining this aspect of self-care provides insight on the overall system. This research examines patients with a chronic illness and their use of online health communities, with a particular focus on their reciprocal behaviors and the impact this support system has on their overall health state. By examining these aspects of the healthcare services ecosystem, we can better improve our understanding of these phenomena. / Ph. D.

Thesis advisor: Mary Troxell / This thesis explores the flaws of classical autonomy in Western healthcare, and alternatively proposes a feminist ethics of care relational autonomy in healthcare settings. It proceeds in four chapters: a brief history of classical autonomy, autonomy's role in healthcare and medical ethics, an introduction to relational autonomy, and relational autonomy's focus on marginalized populations in Western healthcare. It concludes that to address the disconnect in Western healthcare between the patient, provider, and healthcare system, we need to shift to a more relational view of society. / Thesis (BA) — Boston College, 2022. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.

Indiana University-Purdue University Indianapolis (IUPUI) / With increases in the quantity and quality of healthcare related data, data mining tools have the potential to improve people’s standard of living through personalized and predictive medicine. In this thesis we improve the state-of-the-art in data mining for several problems in the healthcare domain. In problems such as drug-drug interaction prediction and Alzheimer’s Disease (AD) biomarkers discovery and prioritization, current methods either require tedious feature engineering or have unsatisfactory performance. New effective computational tools are needed that can tackle these complex problems. In this dissertation, we develop new algorithms for two healthcare problems: high-order drug-drug interaction prediction and amyloid imaging biomarker prioritization in Alzheimer’s Disease. Drug-drug interactions (DDIs) and their associated adverse drug reactions (ADRs) represent a significant detriment to the public h ealth. Existing research on DDIs primarily focuses on pairwise DDI detection and prediction. Effective computational methods for high-order DDI prediction are desired. In this dissertation, I present a deep learning based model D 3 I for cardinality-invariant and order-invariant high-order DDI pre- diction. The proposed models achieve 0.740 F1 value and 0.847 AUC value on high-order DDI prediction, and outperform classical methods on order-2 DDI prediction. These results demonstrate the strong potential of D 3 I and deep learning based models in tackling the prediction problems of high-order DDIs and their induced ADRs. The second problem I consider in this thesis is amyloid imaging biomarkers discovery, for which I propose an innovative machine learning paradigm enabling precision medicine in this domain. The paradigm tailors the imaging biomarker discovery process to individual characteristics of a given patient. I implement this paradigm using a newly developed learning-to-rank method PLTR. The PLTR model seamlessly integrates two objectives for joint optimization: pushing up relevant biomarkers and ranking among relevant biomarkers. The empirical study of PLTR conducted on the ADNI data yields promising results to identify and prioritize individual-specific amyloid imaging biomarkers based on the individual’s structural MRI data. The resulting top ranked imaging biomarkers have the potential to aid personalized diagnosis and disease subtyping.

MSc (Med), Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand / During my interaction with various healthcare professionals while pursuing my post graduate degree, it was evident that a number of them were uninformed about refugees‘ rights.1 There was a predominant misconception that refugees are a burden to South Africa‘s already-constrained health care resources. Some of the healthcare professionals that I spoke to pointed out that they would care for all patients regardless of whether they were refugees or not, because they felt that they had a moral obligation to do so and because professional ethics required them to do so. This was the motivation behind my research.2 As observed by Bilchitz (2005: 5), the term „right to health‟ is a shorthand expression for two elements; the right to health care and the right to a healthy environment. This research report focuses on the right to health which includes access to healthcare services as one of the components of the right to health. It is not oblivious of other related and interdependent rights and it is not in any way intended to undermine the importance of other rights to health. For the most part, I centre my research report in the context of South Africa. In line with the above, the research report recognises the fact that the obligation of the states under international law extends to non-state actors. However, this 1 A refugee is defined by the Department of Home Affairs South Africa (2009) as ―Anyone fleeing from individual persecution, human rights violations or armed conflict in the land of their origin‖. 2 In my further studies, I hope to compliment this research report with empirical research. 7 research is limited to the state‘s obligations within the public healthcare sector. The research report takes an entitlement approach because entitlement empowers refugees by: 1. It gives them a base on which to stand up for themselves and for all persons past and present who, in the face of persecution, have become refugees; and 2. It allows refugees to draw attention to and demand the satisfaction of their rights (Liebenberg 2006: 20; Williams 2005: 446);and 3. It uses the legal process in order to obtain the fulfilment of their needs (ibid: 33-34);and 4. It aids in the pursuit of social justice as Pieterse (2006: 447) puts it: ... by demanding the acceleration of structural reforms that would put an end to prevailing hardship and by creating a space for collective mobilisation around such structural reforms. Although in some instances the research report refers to provisions and studies conducted on foreigners,3 this study is mainly focused on refugees and asylum seekers. However some of issues affecting foreigners in general inadvertently affect refugees as well. Overall, my research looks at the general rights of refugees. It acknowledges that there are specific rights that apply to specific classes of refugees.4 Lastly, the use of 3 A ‗foreigner means an individual who is neither a citizen nor a resident.‘ ( see Yacoob J.‘s ruling in Lawyers for Human Rights v Minister of Home Affairs & Another CCT 18/03 4 These include women and children amongst others. See Convention on the Elimination of all forms of Discrimination Against Women (CEDAW 1979); Convention on the Rights of the Child (CRC, 1989), in article 24 and related regional treaties. Also see s 28 of the RSA Constitution. 8 the term refugee in the study is intended for convenience and includes asylum seekers. The main thesis of the study is that states, as promoters and protectors of refugees‘ right to health, have an obligation to put in place all necessary measures that will aid refugees to full realisation of their right to access healthcare services.

Throughout most of human history, justice has been perceived as an extremely important virtue. The primary objective of this study is to investigate the meaning of justice with a focus on a particular subject—pricing, specifically as it pertains to healthcare. In addition to the primary goal, there are also some secondary objectives: uncovering the procedure of healthcare pricing, revealing the role of government in achieving justice of healthcare pricing, and identifying the influential factors that affect the formation of people’s understanding of justice regarding healthcare pricing. The findings indicate that the equity perspective and the perspective of the need principle have substantial influence on the formation of people’s understanding of justice with regard to healthcare pricing. From the equity perspective, people believe that a just healthcare pricing should be reasonably based on cost. From the need principle perspective, people believe that just healthcare pricing should guarantee the affordability of healthcare, especially basic care. In regard to the role of government, a majority of participants believe that the government-market mixed mechanism is the most just pricing mechanism and government should play the role of a regulator. Government interventions should strive toward assisting the spontaneous forces of the market competition. Finally, findings in this study state that the participants’ general belief of distributive justice exerts a significant effect upon their understanding of justice regarding healthcare pricing. However, there is no one-to-one correspondence between these two. These findings prove that people have the tendency to treat healthcare as a special good and view justice of healthcare pricing as a particular subject to which the general belief of distributive justice may not be applicable. By focusing on justice of healthcare pricing, this study bridges the research gap and contributes to the literature on ethical study of pricing. The identifications of the popularly shared understanding of justice regarding healthcare pricing and the proper role of government provide important reference information to governments and policy makers, enlightening people with new solutions to some pressing healthcare issues.

For this study, in-depth, semi-structured interviews were conducted with 16 transgender adults who lived, or had previously lived, in Mississippi and sought healthcare services in the state. The questions asked focused on identifying the barriers to care that these individuals faced as well as the strategies for navigating the barriers they employed. Recommendations for providers were also considered.

Title: Designing a Survey Instrument to Evaluate K-12 Educators Perception of Well-being Authors: Trystan Innes, Amanda M.S. Frasier PhD, and Chad R. Frasier PhD Introduction: For several years, the United States has faced an increasingly growing teacher shortage as measured by increased vacancies for certified positions 1–3. This shortage is caused by both a decreased enrollment in teacher preparation programs (reduction in those entering the profession) and greater numbers of staff turnover (increase in those leaving the profession) and schools in the South are disproportionately impacted 4. The use of non-invasive measures of heart rate has recently gained an increase in attention, especially with the prevalence of watch-based measurements. These emerging technologies have increased the availability of these measures outside of clinical settings, but the utility of these measures has not been validated. A growing measure companies claim to use is heart rate variability (HRV), which closely approximates the output of the autonomic nervous system. Several studies have linked changes in HRV to mood 15–17, stress18–22, cardiovascular health23–25, and exercise performance and recovery 26–28. However, the utility of the wrist base measurements may be overstated, and expert consensus suggests the use of these devices may become disruptive to healthcare until more is known about how the data relates to a person's health and well-being (29. Overall, there is a gap in research on teacher health and well-being that includes the use of objective measures 34. Methods: A review of current literature for keywords such as occupational stress, teacher, well-being, health, and heart-rate variability. Surveys that addressed well-being were isolated from these studies. Surveys were evaluated on scoring system, question format, experimental group population and relevance to well-being. The findings were incorporated into a modified Teacher Stress Inventory (TSI) survey. The finalized survey was uploaded into Qualtrics for dissemination. The survey will be administered to K-12 educators at schools in northeast Tennessee. These schools will be comprised of both rural and city schools. Participants will also be from schools with variations in socioeconomic levels and population density. Surveys will be scored in accordance with the guidelines established in the Teacher Stress Inventory. In addition, questions from the Effort-Reward Imbalance (ERI) survey were included. Where there was a potential overlap in questions between the TSI and ERI, answers were coded for scaling according to ERI in addition to the TSI. Results: Once the survey has been completed, participants who fit the inclusion criteria will be selected and fitted with an Equivital monitor to track their movement, breathing rate, and ECG over a 24-hour period. In addition, during the fitting of the device, participants will answer the WHO-5 questionnaire which will be used to longitudinally track well-being during the study. ECG data will be used to analyze heart rate variability (HRV) in addition to other ECG parameters. Survey scores and Equivital measures will then be investigated for potential correlation. Conclusion: The survey constructed will serve the foundation in the future research project for evaluating the relationship between HRV and teacher perceptions of well-being.