Science, Technology and Society

This senior capstone project talks though the history of gene therapy and the response by the scientific community to regulate this technology. It breaks down the ethical frameworks used in this regulation and discusses how the advancement of CRISPR gene editing has the potential to undermine these frameworks via biopolitical forces.

Executive Summary: Ukraine's financial and political plight since the fall of the Soviet Union has had a substantial negative impact on the health of its people. For decades, common indicators of health dropped to pre-independence levels, opposite of global trends. Regrettably Ukraine's underfunded and inefficient Semashko healthcare model has done little to ameliorate the problem and resulted in limited financial protection with out-of-pocket expenses dominating health spending. Sensitive to these issues, the Ukrainian government began a reform in 2018 with the creation of the National Health Service of Ukraine. The health service is designed to give citizens access to any level of care with an emphasis on primary care and takes advantage of new technologies to improve transparency. Its single payer structure gives more administrative power to the local level, with the aim of reducing the cost of healthcare overall through increased efficiency and buying power. While the reform won't be fully implemented until 2020, initial figures look promising as over 12 million Ukrainians have already signed up for the NHSU. To truly achieve universal health coverage, however, the NHSU will need further expansion after 2020 as current estimates suggest that only half of the population will be covered.

Chapter 1: Introduction The number of women of color majoring in science, technology, engineering, and mathematics (STEM) and obtaining STEM careers remains significantly low despite the high number of women attending college. According to the Civil Rights Act and the Equal Opportunity Employment Commission of the 1960s, employers must diversify their hiring pool and stop discriminatory hiring practices against women and minorities across all industries, including STEM. 1 Shifting workplace culture to allow more women, especially women of color, to feel welcome in higher education and laboratories amongst mostly white male colleagues are demanding. The barriers to entry within the scientific community are even more laborious for women to overcome. While the number of women in science increased overtime, the numbers do not reflect real equity for women of color. 2 Despite laws calling for more diversity in the workplace, significant gender and race disparities remain in numerous fields, including STEM. Even though more women attend college now than men, women are still underrepresented in science and engineering (S&E) majors. In 2016, women earned half of science and engineering bachelor's degrees, but women only received 44% of master's degrees and 41% of doctorate degrees. 3 We observe even lower numbers for minorities in STEM when compared to women. In 2016, underrepresented minorities (Hispanics or Latinos, Blacks or African Americans, and American Indians or Alaska Natives) earned 21.6% of bachelor's degrees, 13.2% of master's degrees, and 8.8% of doctorate

In my undergraduate thesis, I argue that the opioid epidemic poses challenges but also opportunities for emergency departments to assess and improve their performance under duress for the betterment of future generations and ailments to come. I first delve into the history of emergency medicine as a specialty to put its recent emergence into context. Subsequently, I will discuss the opioid epidemic, its origin, and various causes that have contributed to its relevance and significance in public health. Then, I will examine data from emergency departments throughout the United States to track performance. After, I will describe opioid overdose cases from emergency departments throughout the country and strategies they have implemented to combat the epidemic. I will then discuss the relevance of social determinants of health. Last, I will conclude by tying in my thesis argument with the COVID-19 pandemic.

Background
Measures of vascular dysfunction are related to adverse cardiovascular disease (CVD) outcomes in non‐Hispanic, White populations; however, data from Black individuals are limited. We aimed to investigate the associations between novel hemodynamic measures and prevalent CVD in a sample of Black individuals.

Methods and Results
Among older Black participants of the Jackson Heart Study, we assessed noninvasive vascular hemodynamic measures using arterial tonometry and Doppler ultrasound. We assessed 5 measures of aortic stiffness and wave reflection (carotid‐femoral pulse wave velocity, pulse wave velocity ratio, forward pressure wave amplitude, central pulse pressure, and augmentation index), and 2 measures of microvascular function (baseline and hyperemic brachial flow velocity). Using multivariable logistic regression models, we examined the relations between vascular hemodynamic measures and prevalent CVD. In models adjusted for traditional CVD risk factors, higher carotid‐femoral pulse wave velocity (odds ratio [OR],1.25; 95% CI, 1.01–1.55; P=0.04), lower augmentation index (OR, 0.84; 95% CI, 0.70–0.99; P=0.05), and lower hyperemic brachial flow velocity (OR, 0.77; 95% CI, 0.65–0.90; P=0.001) were associated with higher odds of CVD. After further adjustment for hypertension treatment, lower augmentation index (OR, 0.84; 95% CI, 0.70–0.99; P=0.04) and hyperemic brachial flow velocity (OR, 0.79; 95% CI, 0.67–0.94; P=0.006), but not carotid‐femoral pulse wave velocity (OR, 1.23; 95% CI, 0.99–1.051; P=0.06), were associated with higher odds of CVD.

Conclusions
In a sample of older Black individuals, more severe microvascular damage and aortic stiffness were associated with prevalent CVD. Further research on hemodynamic mechanisms that contribute to cardiovascular risk among older Black individuals is merited.

During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized polymerase chain reaction or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact, and Connecticut colleges and universities used a variety of approaches to reopen campuses to residential students.

IMPORTANCE During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized polymerase chain reaction or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact, and Connecticut colleges and universities used a variety of approaches to reopen campuses to residential students. OBJECTIVE To characterize institutional reopening strategies and COVID-19 outcomes in 18 residential college and university campuses across Connecticut. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data on COVID-19 testing and cases and social contact from 18 college and university campuses in Connecticut that had residential students during the 2020-2021 academic year. EXPOSURES Tests for COVID-19 performed per week per residential student. MAIN OUTCOMES AND MEASURES Cases per week per residential student and mean (95% CI) social contact per week per residential student. RESULTS Between 235 and 4603 residential students attended the fall semester across each of 18 institutions of higher education in Connecticut, with fewer residential students at most institutions during the spring semester. In census block groups containing residence halls, the fall student move-in resulted in a 475% (95% CI, 373%-606%) increase in mean contact, and the spring move-in resulted in a 561% (95% CI, 441%-713%) increase in mean contact compared with the 7 weeks prior to move-in. The association between test frequency and case rate per residential student was complex; institutions that tested students infrequently detected few cases but failed to blunt transmission, whereas institutions that tested students more frequently detected more cases and prevented further spread. In fall 2020, each additional test per student per week was associated with a decrease of 0.0014 cases per student per week (95% CI,-0.0028 to-0.00001). CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that, in the era of available vaccinations and highly transmissible SARS-CoV-2 variants, colleges and universities should continue to test residential students and use mitigation strategies to control on-campus COVID-19 cases.

Background Measures of vascular dysfunction are related to adverse cardiovascular disease (CVD) outcomes in non‐Hispanic, White populations; however, data from Black individuals are limited. We aimed to investigate the associations between novel hemodynamic measures and prevalent CVD in a sample of Black individuals. Methods and Results Among older Black participants of the Jackson Heart Study, we assessed noninvasive vascular hemodynamic measures using arterial tonometry and Doppler ultrasound. We assessed 5 measures of aortic stiffness and wave reflection (carotid‐femoral pulse wave velocity, pulse wave velocity ratio, forward pressure wave amplitude, central pulse pressure, and augmentation index), and 2 measures of microvascular function (baseline and hyperemic brachial flow velocity). Using multivariable logistic regression models, we examined the relations between vascular hemodynamic measures and prevalent CVD. In models adjusted for traditional CVD risk factors, higher carot...

Simone Karuga, and Olivia Weathers for their extensive feedback and support during our pod meetings. Thank you to Lily Carruthers for convincing me to become an STS major and for being my cheerleader throughout writing this thesis. I'm lucky to call you a friend and I cannot wait to continue our friendship over the next two years at the Yale School of Public Health. And last, to Kelly Kohler, Daniel Moskowitz, and Omri Bareket, thank you all for being so formative in my journey as an EMT. I'm lucky to call you not just colleagues, but family. The largest source of inspiration for this thesis would not have happened without taking the EMT class during my freshman year, and I'm glad to have made memories with all of you that I will cherish for a lifetime.