Millard County, Utah, rural and sparsely populated, continues to experience challenges in recruiting and retaining primary health care providers. My study addressed the lack of a rigorous and systemic analysis of this problem by collecting and analyzing data from a series of semi-structured interviews conducted between January and March 2019. These interviews were with nineteen of the twenty-four known health care providers who began practice in the county from the mid1980s to 2018, as well as with four administrators. The study, taking advantage of this comprehensive analysis, provided a more extensive understanding of the root causes underlying the recruitment and retention shortcomings. Findings showed that decisions to stop practice in the county were not typically made for a single over-riding reason but occurred when the cumulative effect of negative experiences reached a tipping point, prompting the provider to seek another practice venue. Providers who left reached this tipping point in spite of most having a rural background. The study recommended implementing a comprehensive and on-going support program aimed at addressing providers concerns. The stressors associated with rural health care practices need to be regularly assessed and resolved in a timely fashion.

Introduction: The COVID-19 pandemic has increased the magnitude of mental illnesses such as depression, not only in the general population, but also in healthcare personnel. However, in Peru the prevalence, and the associated factors for developing depression in healthcare personnel, are not known. The objective was to determine the prevalence and identify the factors associated with depression in healthcare personnel, in the context of the SARS-CoV-2 pandemic. Methods: An analytical cross-sectional study was carried out from May to September, 2020 in healthcare establishments. A sample of 136 health workers were included and a survey was applied to collect the data. Depression as a dependent variable was measured using the Zung self-report scale. To identify the associated factors, the bivariate and multivariate analysis was performed by logistic regression with STATA v 14. Results: The prevalence of depression was 8.8% (95%CI, 4.64-14.90). Having a family member or friend who had died from COVID-19 was associated with depression (OR = 6.78; 95%CI, 1.39-32.90; P = 0.017). Whereas the use of personal protective equipment was found to be a protective factor against developing depression (OR = 0.03; 95%CI, 0.004-0.32; P = 0.003). Conclusions: Approximately 1 in 10 healthcare professionals and technicians developed depression during the COVID-19 pandemic in this study. In addition, having relatives or friends who had died from COVID-19 was negatively associated with depression and use of personal protective equipment was identified as a protective factor. / Revisión por pares

Cerebrovascular accidents (CVAs) are a leading cause of morbidity and mortality in the United States. Metabolic derangements such as hypoglycemia, infections, brain masses or lesions, neurodegenerative disorders, neuropathies, myelopathies, seizures, syncope, types of migraines, and many other disorders may mimic CVA. Our case presents a 38-year-old female who was evaluated in the emergency department with a three- hour history of headache, lethargy, left- sided upper extremity weakness, facial droop, and dysarthria. A CVA workup was initiated and she immediately underwent a computed tomography (CT) scan of the head which revealed no intracranial hemorrhage. She was unable to provide a thorough medical history due to lethargy, however she was able to answer yes/no questions to screen for tissue plasminogen activator (tPA) qualification. She qualified based on her screening results and was administered tPA for her presumed ischemic CVA. She was then monitored in the intensive care unit for twenty-four hours. Due to reoccurrence of headache and left-sided weakness, as well as recent administration of tPA increasing risk of hemorrhage, she underwent two subsequent negative non- contrast head CT scans to rule out bleeding during that time. On hospital day two, magnetic resonance imaging (MRI) of the head, neck, and spine were performed which were also negative for infarct or hemorrhage. A more detailed history from our patient revealed previous migraine headaches, but her left sided weakness and dysarthria were new symptoms. With this information, it was suspected that she was suffering from a hemiplegic migraine, a rare mimic of CVA. Prochlorperazine, diphenhydramine, valproic acid, and corticosteroids were administered for migraine treatment, which aborted her symptoms entirely. Topiramate was then started for migraine prophylaxis. Daily low-dose aspirin was also initiated due to inability to fully rule out CVA/transient ischemic attack (TIA). An outpatient neurology follow up was scheduled on discharge. In clinical practice, hemiplegic migraines and CVA/TIA may be difficult to differentiate as symptoms often overlap. A detailed history and physical exam with careful attention to associated symptoms and timing of symptom onset is essential to formulating a correct diagnosis. This must be done quickly, as tPA is a high-risk medication with a narrow time window for administration. In conclusion, not all disease processes have an available “gold standard” diagnostic test to differentiate similar diagnoses. MRI of the brain is usually performed to differentiate ischemic CVA from TIA; however, imaging is not useful to differentiate hemiplegic migraine from TIA. Therefore, performing a thorough history, physical exam, and chart review is paramount to provide patients with the correct treatment as well as prevent adverse outcomes. It is the responsibility of the clinician to make difficult decisions weighing the risks and benefits of providing various treatments or interventions, and to know the complications of those treatments. Disease processes mimicking CVA must be considered in all patients, as treating an incorrect diagnosis can have devastating effects.

As NASA and other space programs around the world prepare to send astronauts into space for longer missions, it is becoming imperative to understand the biological effects of spaceflight on the human body. In order to better understand how the long-term spaceflight environment affects humans biologically, researchers often utilize other model organisms, like mice, whose biological systems are comparable to human body systems. Our study was performed to determine if spaceflight had any effect on the thickness of the muscular layers of the uterine tissue of female mice. In other words, how does the thickness of the muscular layers in the uterus of spaceflight mice compare to that of control mice that were not subjected to spaceflight. For this study mice were divided into 4 groups (flight animals, baseline animals, vivarium controls, and ground controls) and the flight mice subjected to 37 days of spaceflight. Upon tissue retrieval and histological preparation, five random measurements of the outer longitudinal muscular layer and five random measurements from the inner circular muscular layer of each tissue sample were made. The average thickness for each layer was then calculated and statistical analysis used to determine differences between the four groups of mice. At the time of this presentation final measurements and statistics had not been completed.

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Gun violence is a public health crisis in the United States. Research shows that violence functions similarly to a communicable disease. An exposure such as someone witnessing violence or being a victim of violence is a major risk factor to the exposed person becoming a perpetrator of violence themselves. Victims of gun violence are seen in emergency rooms at alarming rates and despite gun related deaths increasing over the past few decades, there is not a significant quantity of research on violence intervention. As physicians are key players in individual and community health, they have an ethical imperative to intervene. Both doctors and patients believe that physicians can play a role in addressing gun safety and risk of firearm injury. Gun violence interventions by physicians can be either preventative, working to avoid an initial firearm related injury, or interventional, working to avert additional firearm related injuries. Outpatient clinical attempts to prevent firearm injury can be modeled after pre-established methods like bicycle helmet safety screening. Inpatient or post injury methods include more comprehensive approaches that focus on breaking the cycle of violence and preventing reinjury. Gun violence is a public health crisis that requires physician action. / Urban Bioethics

This research examined the impact of ED process complexity on hospital quality outcomes. Nine emergency department nurse managers from hospitals in Mississippi, Alabama, and Louisiana were interviewed regarding processes of registration, laboratory testing, medication administration, radiology, and discharge. Interview data was coded according to variables in proposed equations for patientocused, providerocused, and overall process complexity. Hospital quality was measured using existing process of care, outcome of care, and patient satisfaction standards. Results showed a strong negative correlation between process complexity and overall quality, suggesting that hospitals with lower process complexity experience higher quality outcomes. Regression analysis showed that the average number of patient steps in a process and the overall complexity the registration process were significant predictors of overall quality. Methods of reducing patient steps and registration process complexity are discussed.

Thesis advisor: Andrew Barrette / The field of health care encompasses a myriad of ethical dilemmas surrounding the core conceptions of goodness and values. This thesis discusses the method of intentionality analysis, especially as it is explicated by Bernard Lonergan and his students, to raise awareness of a distortion of values related to health and health care in the United States. Health is a vital value that is meant to be upheld with absolute precedence by health care institutions. Values, of individuals and of institutions, as intentional responses to feelings, must be ordered in a specific way to align with the objective scale of values. Through the orientation toward, then the realization of true values, the good of order operates. Despite that health is the preferred value, health care institutions in the United States do not always operate in accordance with ordered values; there is a distortion of values experienced at the institutional level. In the United States, financial gain and greed compete with the execution and achievement of the true value of health and thus also of the terminal value. This disruption of the good of order contributes to the decline of human good, which may be remedied by conversion. / Thesis (BA) — Boston College, 2023. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.