Thesis (MPH.) -- University of Limpopo, 2020 / Background Health status and access to adequate healthcare are vulnerabilities that undocumented migrants face in the receiving country. The purpose of the study was to explore the experiences of undocumented Zimbabwean migrants on accessing public healthcare services in the Tshwane Metro, South Africa. Methods A qualitative, descriptive and exploratory research was conducted to explore the experiences of undocumented Zimbabwean migrants on accessing public healthcare services in Tshwane Metro, South Africa. A group of undocumented Zimbabwean migrants (n=20) were purposively sampled. Data were analysed using a grounded approach. Results The study has highlighted the challenges undocumented Zimbabwean migrants living in the Tshwane Metro, South Africa face when trying to access public healthcare services. The study also highlighted the alternative health-seeking strategies the migrants were using to access health services. The findings revealed that there were tensions between public health workers and undocumented migrants. These tensions were contrary to international compacts as well as the policy provisions of the South African government. Conclusion A human rights paradigm needs to be central to any dialogue regarding migrants, legal or illegal, as their health status was invariably entwined with that of the citizens of South Africa.

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Recent developments in implantable medical devices (IMDs) have created a need for communication systems integrated directly into the implant with feedback data for various sensing systems. The need for modern communication techniques, power delivery systems, and usable interfaces for smart implants present an interesting challenge for engineers trying to provide doctors and medical professionals with the best resources available for medical research. This dissertation will cover the design of an integrated CMOS transceiver and near-field inductive link used for an IMD and the accompanying CMOS front end for the application space of neural recording in the brain of lab mice. The design process of the CMOS IC, along with thinning techniques, the nearfield inductive link, and the design of an external reading system will be discussed in detail. The various wireless power and data telemetry techniques applicable for IMDs and their strengths and weaknesses will also be described. Software techniques and implementation for real-time analysis of a high data rate communication system from the designed IMD will be covered. Finally, transceiver verification will be given for both power and data telemetry under various scenarios, with front end verification performed via controlled lab bench experiments using input sinusoidal wave forms.

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Real-world evidence (RWE) plays a crucial role in understanding the impact of medical interventions and uncovering disparities in clinical practice. However, confounding bias, especially unmeasured confounding, poses challenges to inferring causal relationships from observational data, such as estimating treatment effects and treatment responses. Various methods have been developed to reduce confounding bias, including methods specific for detecting and adjusting for unmeasured confounding. However, these methods typically rely on assumptions that are either untestable or too strong to hold in practice. Some methods also require domain knowledge that is rarely available in medicine. Despite recent advances in method development, the challenge of unmeasured confounding in observational studies persists. This dissertation provides insights in adjusting for unmeasured confounding by exploiting correlations within electronic health records (EHRs). In Aim 1, we demonstrate a novel use of probabilistic model for inferring unmeasured confounders from drug co-prescription pattern. In Aim 2, we provide theoretical justifications and empirical evidence that adjusting for all (pre-treatment) covariates without explicitly selecting for confounders, as implemented in the large-scale propensity score (LSPS) method, offers a more robust approach to mitigating unmeasured confounding. In Aim 3, we shift focus to the problem of evaluating fairness of treatment allocation in clinical practice from a causal perspective. We develop a causal fairness algorithm for assessing treatment allocation. By applying this fairness analysis method to a cohort of patients with coronary artery disease from EHR data, we uncover disparities in treatment allocation based on gender and race, highlighting the importance of addressing fairness concerns in clinical practice. Furthermore, we demonstrate that social determinants of health, variables that are often unavailable in EHR databases and are potential unmeasured confounders, do not significantly impact the estimation of treatment responses when conditioned on clinical features from EHR data, shedding light on the intricate relationship between EHR features and social determinants of health. Collectively, this dissertation contributes valuable insights into addressing unmeasured confounding in the context of evidence generation from EHRs. These findings have significant implications for improving the reliability of observational studies and promoting equitable healthcare practices.

Indiana University-Purdue University Indianapolis (IUPUI) / Work engagement of registered nurses (RNs) has gained attention in health care, as an organizational process that is requisite to promoting optimal patient outcomes. Improving patient outcomes has caused a movement to examine what can be done to bridge the disparity between good and excellent care. Standards that enhance RN engagement to promote professional care are seen as vital to excellence. Magnet designation, awarded by the American Nurses Credentialing Center, signifies an organization meets such standards. Therefore, the purpose of this study was to evaluate whether a correlation exists between RN engagement and the organizational structures common to Magnet designation. This study also evaluated the influence of social and institutional demographics on the relationship between engagement and Magnet designation. The variables in this study included: age (generation), gender, nursing degree, years of RN experience, years of unit longevity, shift, hours scheduled and worked per week, percentage of time in direct patient care, nursing unit, and shared governance council participation. Finally, this study evaluated the influence of RN perception related to organizational support for work on the relationship between engagement and Magnet designation. A total of 370 RNs in Magnet (n = 220) and non-Magnet (n = 150) designated hospitals completed a 17-item engagement survey and a 15-item demographic survey. Major findings of the study indicated no significant difference in RN engagement between nurses who work at Magnet versus non-Magnet designated hospitals. Within the Magnet sample, significant relationships were found between engagement and shift, years of RN experience in any clinical setting, and RN perceptions related to organizational support for work. Scatter plots for nursing experience showed positive slopes for total engagement, vigor, dedication, and absorption. Post-hoc results for RN perception related to organizational support for work identified the significant areas of engagement were total engagement, vigor, and absorption. No significant post-hoc results were noted for the variable of shift. Through significant and non-significant findings, several insights were gained about engagement. As a result of this study, leadership can better assess the needs of the RN workforce to provide what RNs perceive to be important to professional practice and RN engagement.