Now showing items 21-40 of 5149

    • Mitigating Bias in Medical Education at the Intersection of Standardized Patients and Medical Students

      Jones, Nora L. (Temple University. Libraries, 2024-05)
      Purpose: The Standardized Patient [SP] Program is a potential avenue through which students from races and ethnicities underrepresented in medicine [URiM] experience bias, due in part to the inherent subjectivity of an SP’s evaluation of the doctor-patient interaction. In most training programs, medical students are assessed on their clinical and interpersonal skills via simulated encounters where students assume the doctor role and SPs act as patients. Researchers conducted this qualitative study to (1) understand the SPs’ perception of their role within the Objective Structured Clinical Exam and medical school education, (2) investigate biases that medical students may experience during SP evaluations of simulated clinical encounters.Methods: Participants were recruited from Lewis Katz School of Medicine at Temple University. Interviews and focus groups were conducted between August through October of 2022. A total of 14 medical students, 11 of which self-identified as URiM, were distributed into 6 focus groups. A total of 9 SPs were interviewed, 3 of which self-identified as non-white ethnic minorities. All interviews were then transcribed and analyzed using a combination of first-cycle coding methods. In the final stages of analysis, we examined the data to determine frequent themes across the study populations. Results: The results demonstrated conflicting sentiments between SPs and students. Although SPs described an intensive training process that promoted standardization of DPI scoring across SPs, URiM students reported high interrater variability, referring to the variation in the interpretation of a student’s communication skills by SPs. The consensus amongst minority students was that SPs evaluate students more leniently in interactions where the SP and student share ethnic identities. The themes present in the resulting data aligned closely with a social determinants of health conceptual framework, illustrating how disregarding the topic of implicit bias in the SP Program leads to a downward trajectory of differential attainment. Conclusion: Although medical education administrators have begun shifting their attention towards diversity, equity, and inclusion initiatives, there has been minimal focus on the key perspectives necessary to navigate this space. Our research analyzes those perspectives as an important first step towards acknowledging and effectively mitigating bias in medical education programs.
    • Methods of Model Uncertainty: Bayesian Spatial Predictive Synthesis

      Airoldi, Edoardo; McAlinn, Kenichiro; Dong, Yuexiao; Wattal, Sunil (Temple University. Libraries, 2024-05)
      This dissertation develops a new method of modeling uncertainty with spatial data called Bayesian spatial predictive synthesis (BSPS) and compares its predictive accuracy to established methods. Spatial data are often non-linear, complex, and difficult to capture with a single model. Existing methods such as model selection or simple model ensembling fail to consider the critical spatially varying model uncertainty problem; different models perform better or worse in different regions. BSPS can capture the model uncertainty by specifying a latent factor coefficient model that varies spatially as a synthesis function. This allows the model coefficients to vary across a region to achieve flexible spatial model ensembling. This method is derived from the theoretically best approximation of the data generating process (DGP), where the predictions are exact minimax. Two Markov chain Monte Carlo (MCMC) based algorithms are implemented in the BSPS framework for full uncertainty quantification, along with a variational Bayes strategy for faster point inference. This method is also extended for general responses. The examples in this dissertation include multiple simulation studies and two real world data applications. Through these examples, the performance and predictive power of BSPS is shown against various standard spatial models, ensemble methods, and machine learning methods. BSPS is able to maintain predictive accuracy as well as maintain interpretability of the prediction mechanisms.
    • Quantification of Group Dynamics in Conversation Treatment for Aphasia

      DeDe, Gayle; Maas, Edwin; Martin, Nadine, 1952-; Hoover, Elizabeth (Temple University. Libraries, 2024-04)
      Introduction: Conversation treatment for individuals with aphasia (IwAs) aims to enhance language and communication skills within naturalistic settings. Group dynamics, including psychosocial support (PSS) and vicarious learning (VL), are important components of this treatment. However, the lack of established aphasia-friendly methods for quantifying group dynamics impedes understanding of its contribution to treatment efficacy. This study addresses three key research goals: (1) Can group dynamics be reliably quantified? (2) Do measures of group dynamics vary with group size or time? (3) Are group dynamics linked to changes in self-reported psychosocial health measures? Methods: IwAs were assigned to participate in either a large group or dyadic condition as part of a larger study. Participants completed multiple standardized assessments before and after receiving conversation treatment for one hour twice a week for ten weeks. A coding system was developed to track PSS and VL during sessions. Video recordings of sessions at the start (Session 2) and end (Session 19) of the treatment period were analyzed for five large groups and six dyads, with seven additional dyads coded for Session 19 after reliability was confirmed. Intrarater and interrater reliability were assessed by recoding 21% of the videos randomly. Results: To address the first research goal, group dynamics were defined and then a code was created to represent occurrences of PSS and VL. After establishing a reliable coding system, instances of PSS and VL were compared across size conditions to address the second research goal. The results suggested that PSS differed between conditions later in treatment, but VL did not. For research goal three, the data suggest that large groups experience larger gains in quality of life measures, possibly due to increased exposure to PSS. Conclusion: Findings indicate that group dynamics can be reliably tracked and used for quantitative analysis. PSS was more common in groups than dyads later in the 10 week treatment period, but VL did not vary across conditions or at the start or end of treatment. Further, there is some evidence that PSS in larger groups contributes to improvements in quality of life measures.

      Tuohy, Brian; Tuohy, Brian; Jones, Nora L.; Averill, Catherine (Temple University. Libraries, 2024-05)
      This thesis is predicated on two ideas: that physical activity is a social determinant of health; and that the American mass incarceral system is a product of structural racism. First, I review the well-known benefits of physical activity and examine the very sparse existent literature on women exercising in American jails and prisons. I then address health disparities for incarcerated populations, exploring historical policies and laws that shaped the current climate of incarceral health. Next, I discuss my motivations and the challenges associated with starting the wellness program I created at a local jail where I lead a workout and meditation class for the female population. I utilize a bioethical lens to compare similarities between my experience in the hospital as a medical student and as a physical fitness instructor at the correctional facility. Finally, I use behavioral theories to highlight the impact exercise can have on individuals and the benefits that extend beyond the bodily and can translate into the increased life skills and personal development needed to impact social change. I conclude with an analysis of how community- based interventions that allow for meaningful engagement, such as exercise programming, can alleviate the stressors associated with incarceration — a physical and metaphorical opportunity for renewal and transformation.

      Herring, Sharon (Temple University. Libraries, 2024-05)
      With food and nutrition insecurity driving diet-related chronic health conditions in urban settings, strategies that facilitate access to fresh fruits and vegetables are imperative. Food is Medicine is a philosophy that embraces the integration of nutrition education and food subsidies into health care. This thesis describes one example of a Food is Medicine program, food prescription programs (FRx), in chronic disease management. While FRx programs vary in length, there are no studies to our knowledge addressing the reasons why patients adhere to FRx long-term. Using a positive deviance approach, we sought to understand positive deviant patient (PDP) practices and characteristics influencing consistent, long-term participation in Temple University's Farm to Families (F2F) fruit and vegetable prescription program. Prior to introducing this case study, I share from an Urban Bioethics lens my reflections on study design, my positionality coordinating research with community members, and how Urban Bioethical principles relate to FRx. I present the F2F case study: we conducted semi-structured, in-depth interviews among 13 PDPs who participated for over three months between 2016 and 2021. Interview transcripts were coded for most common themes. Seven of the 13 PDPs opted to participate in photovoice interviews. I then examine lessons learned from the F2F case study. Lastly, I discuss the sustainability of FRx from an Urban Bioethics lens, starting with considerations of resource allocation of FRx, and ending with integrating FRx into clinical practice and health systems. Despite the complexity of risk factors and sociopolitical forces contributing to food and nutrition insecurity in the United States, food justice is both necessary and achievable. How we as Urban Bioethicists and clinicians choose to approach food insecurity determines our capacity to challenge the status quo and reconstruct the narratives that have perpetuated this issue for far too long. Through a collaborative effort that embraces the experiences of our patients and community members, my aspiration is for food justice to become a reality.
    • We Have Magic To Do: Costume Designing Temple University's Pippin

      Chiment, Marie Anne; Norris, Jason; Ingram, David (Temple University. Libraries, 2024-05)
      The purpose of this thesis is to recount the creative process of designing thecostumes for Temple University’s Spring 2024 production of Pippin. The process begins with the assignment of the production and follows the development of design concepts and throughlines using script analysis. Research and meetings that further influenced the author’s final designs are also discussed. In the second half of the thesis, the process explores unexpected challenges that arose including severe budget cuts, limited sourcing options, and dress rehearsals. The process ends with a reflection from the author about her time at Temple as a graduate student.

      Tuohy, Brian (Temple University. Libraries, 2024-05)
      The discourse surrounding medical error and its ethical implications has become a pivotal focus within healthcare. Thus, this thesis aims to delve into the multifaceted aspects of and influences on medical error and its disclosure, with each chapter progressively shedding light on their complexities and ethical considerations. The overarching argument posits that despite society’s general intolerance for errors and a recognized aim for perfection, error remains an unavoidable and inevitable aspect of the practice of medicine and medical training. There exists an inherent fallibility in healthcare juxtaposed against the gravity of the profession and its consequent medical and legal ramifications when something goes awry. The following ten chapters collectively highlight the intricacies of error management in healthcare through discussions on societal expectations, medical training, error analysis, accountability, systemic influences, patient-provider relationships, legal implications, and bioethical tenets. Ultimately, advocating for a cultural shift towards greater transparency, collective accountability, systemic quality improvement, and support for healthcare professionals to address errors effectively while upholding patient safety and trust. This thesis also recognizes the ethical imperative of error disclosure and the importance of fostering a balanced approach that acknowledges both the inevitability of errors in healthcare and the significant physical, emotional, and financial burdens caused by medical errors.
    • Machine Learning Methods for Autonomous Driving: Visual Privacy, 3D Depth Perception and Trajectory Prediction Modeling

      Tan, Chiu C.; Shi, Justin Y.; Ling, Haibin; Hiremath, Shivayogi (Temple University. Libraries, 2024-04)
      Autonomous driving could bring profound benefits for our society. The benefits range from economic and safety benefits due to the reduction of the number of traffic accidents, to environmental gains due to reduced traffic congestion. However, the utopian future of self-driving vehicles is yet to come. To this end, we propose machine learning methods to address three pivotal aspects of autonomous driving: visual privacy, 3D depth perception, and trajectory prediction modeling. We begin by exploring the crucial issue of visual privacy within person-aware visual systems. We propose the use of depth-information to protect privacy in person-aware visual systems while preserving important foreground subjects and scene structures. We aim to preserve the identity of foreground subjects while hiding superfluous details in the background that may contain sensitive information. In particular, for an input color and depth image pair, we first create a sensitivity map which favors background regions (where privacy should be preserved) and low depth-gradient pixels (which often relates a lot to scene structure but little to identity). We then combine this per-pixel sensitivity map with an inhomogeneous image obscuration process for privacy protection. We tested the proposed method using data involving different scenarios including various illumination conditions, various number of subjects, different context, etc. The experiments demonstrate the quality of preserving the identity of humans and edges obtained from the depth information while obscuring privacy intrusive information in the background. Next, we focus on the label layout problem: AR technologies can overlay virtual annotations directly onto the real-world view of a self-driving vehicle (SDV). Autonomous vehicles operate in dynamic environments, due to the complexity of the traffic scene and the interactions between the participating agents. Overlaying virtual annotations directly onto the real-world view of a SDV, can provide additional context, such as highlighting important information or projecting the future trajectories of other participants. Designing a layout of labels that does not violate domain-specific design requirements, while at the same time satisfying aesthetic and functional principles of good design, can be a daunting task even for skilled visual designers. Presenting the annotations in 3D object space instead of projection space, allows for the preservation of spatial and depth cues. This results in stable layouts in dynamic environments, since the annotations are anchored in 3D space. In this domain, we make two major contributions. First, we propose a technique for managing the layout and rendering of annotations in Virtual/Augmented Reality scenarios by manipulating the annotations directly in 3D space. For this, we make use of Artificial Potential Fields and use 3D geometric constraints to adapt them in 3D space. Second, we introduce PartLabeling: an open source platform in the form of a web application that acts as a much-needed generic framework allowing to easily add labeling algorithms and 3D models. This serves as a catalyst for researchers in this field to make their algorithms and implementations publicly available, as well as ensure research reproducibility. The PartLabeling framework relies on a dataset that we generate as a subset of the original PartNet dataset consisting of models suitable for the label management task. The dataset consists of 1,000 3D models with part annotations. Finally, we focus on the trajectory prediction task in the context of autonomous driving. Predicting the trajectories of multiple participating agents in the context of autonomous driving is a challenging problem due to the complexity of the traffic scene and the interactions between the agents. Autonomous vehicles need to effectively anticipate the behavior of other movingparticipants in the traffic scene (human pedestrians, cyclists, animals, other moving vehicles). The task of modeling human driver behavior, as well as the interactions between the traffic participants must be addressed to enable a safe and optimized autonomous vehicle systems. There are many factors that traffic participants take into consideration in order to safely interact with other traffic participants. Human drivers have sophisticated interaction strategies that come naturally to them. Given the highly interactive nature of traffic scenarios, representing the interactions between multiple participating agents in a traffic scene in the form of a graph structure is a natural conclusion. In order to leverage the influences between multiple agents in a traffic scene, we structure the scene as a graph whose nodes represent the traffic participants. The node features are each agent’s surrounding context encoded as a raster image. For this purpose, we leveragel R-GCN (Relational Graph-Convolutional Netowrks). Then, we propose a novel Cross-Modal Attention Network (CMAN) to encourage interactions between two modalities: 1) the latent features of an ego-agent’s raster image and 2) the latent features of the surrounding agents’ influences on the ego-agent, in a manner that allows these two modalities to complement each other.
    • The Role of Self-Conscious Emotions in Polarized Societies

      Ziegfeld, Adam; Ziegfeld, Adam; Nickerson, David Warwick; Crawford, Nyron; Arceneaux, Kevin; Theodoridis, Alexander (Temple University. Libraries, 2024-05)
      In modern times, there is an increasing tendency to use "us versus them" rhetoric in the political realm. Motivated reasoning literature offers a solution as to how group conflict contributes to outgroup bias. People may develop negative feelings towards outgroups in order to reduce cognitive dissonance and feel better about their judgments. Nevertheless, this is not the situation for everyone. My research aims to understand how peoples’ predisposed tendencies may affect the level of their out-group bias. Drawing from the distinction between shame (a negative sense of identity) and guilt (a response to a specific behavior) in psychology, I hypothesized that self-conscious emotions would moderate the relationship between information about in-group transgressions and out-group bias. To test this, I conducted a survey experiment with three different groups: Men/Women, White/Black people, and Democrats/Republicans. Participants were randomly assigned to watch videos depicting misbehavior from their respective group. Results showed that the proneness to self-conscious emotions did moderate the relationship to some extent, although the connection between shame and guilt proneness was more complex than anticipated. Criticizing one's in-group generally caused people to experience cognitive dissonance and reinforced out-group bias, particularly among those who were highly prone to both shame and guilt. The three-way interaction between treatment, shame proneness, and guilt proneness varied across and within the different identity categories, suggesting that there is no single theory that can entirely explain the degree of out-group bias.
    • The Impact of Soft Costs Associated with the Implementation of New Information Technology in United States-Based Small to Medium Businesses on Productivity

      Rivera, Michael J.; Di Benedetto, C. Anthony; Pang, Min-Seok; Shoham, Amir (Temple University. Libraries, 2024-05)
      This research investigates the influence of "soft costs" on the productivity impact of new information technology (IT) implementations in US-based Small and Medium-sized Businesses (SMBs). Soft costs, distinct from "hard costs," encompass factors such as resistance to change, training, decision-making processes, and error analysis that are not directly quantifiable as financial investments. The study explores the interplay between decision-making and implementation processes in SMBs when introducing new technology and their collective contribution to overall productivity, including additional exploration of resolutions as provided by individuals within organizations across different industries. This dissertation delves into the intricate realm of soft costs within small and medium-sized businesses (SMBs), exploring their impact, management strategies, and implications for organizational success by acknowledging and addressing soft costs for technology purchases specifically, and soft costs in a broader sense, in various industries. Through a meticulous blend of qualitative and quantitative research methods, the study investigates the nuanced dynamics of soft costs, shedding light on their pervasive nature and the challenges they pose for SMBs across diverse industries. The methodology employed in this research includes the design and administration of surveys using Qualtrics XM survey services, aimed at capturing the perceptions and experiences of SMB stakeholders regarding soft costs. Analysis of survey responses reveals a growing awareness of soft costs among individuals within SMBs, yet a notable lack of dedicated resources and attention within organizations to address them effectively. The findings, data which is further processed and analyzed using IBM SPSS and NVivo, underscore the critical need for further research and exploration into soft costs, emphasizing their significance in financial planning, resource allocation, and decision-making processes. By embracing a proactive approach to managing soft costs, SMBs can navigate the complexities of the business landscape with resilience and foresight, ultimately enhancing their long-term viability and success. This dissertation contributes to the existing body of knowledge on soft costs, providing valuable insights and implications for SMBs striving to thrive in an increasingly competitive environment. 
    • The Skilled Labor Gap: The Case of Welders and Machinists

      Mudambi, Susan; Blau, Gary J.; Mudambi, Ram, 1954-; Bazel-Shoham, Ofra (Temple University. Libraries, 2024-05)
      After the COVID-19 pandemic, the United States faced one of the largest labor shortages in recent memory. In 2021, there were 11 million job openings compared to only 6.9 million people who are unemployed yet want to work – a gap of over 4 million workers. Millions of those available openings were skilled labor jobs, and ongoing labor shortages continue to raise many questions. Scholars have long debated the causes and effects of labor shortages, with competing theories and inconsistencies in methodology. This two-part study explores the roles of perceived job attractiveness and skilled labor training and their relationship to skilled labor employment. The first part looks at the national picture of the skilled labor gap, and the second part focuses more specifically on Ohio and Central Ohio. This research develops a model to examine the U.S. and Ohio employment of welders and machinists in the durable goods manufacturing industry to better understand the perceived labor shortages, how they have changed over time, and the influence of key variables. In contrast to popular opinion about the skilled labor gap, the analysis shows that wages and employment have been flat over the last 20 years even as training has increased. Additionally, the results show that these jobs are safer than ever while training and apprenticeships have trended upward. A geographic analysis of Central Ohio also identifies some barriers to work regarding access and infrastructure. These results contribute to scholarly research in labor economics and mesoeconomics. It informs policymakers and firms as to possible strategies to plan for and cope with shortages, such as altering human resource practices, considering diversity hiring strategies, engaging in apprenticeship programs, and developing relationships with post-secondary institutions. This research makes a clear contribution to human resource management theory and practice.
    • Random Matrices and Partitions

      Rider, Brian (Brian C.); Yilmaz, Atilla; Dolgushev, Vasily (Temple University. Libraries, 2024-05)
      We begin by defining an integrable hierarchy called the KP hierarchy in terms of psuedodifferential operators. Unitary-invariant matrix ensembles provide examples of solutions to the KP hierarchy, another class of solutions to the KP hierarchy is given by Riemann surfaces with a line bundle and marked point. The latter solutions are described by the famous Krichever correspondence. At this point we also sketch how to solve Riemann Hilbert Problems which describe the asymptotics of orthogonal polynomials with varying exponential weight. Here we point out a similarity between the solutions of these Riemann Hilbert Problems and the Baker functions of the KP hierarchy. We then turn our focus to models of random three-dimensional partitions, in order to deal with these random shapes the Schur process is introduced and its correlation functions are computed. This gives us a way to find asymptotics for plane partitions and pyramid partitions in the case where all q parameters are going to 1 together. Finally, in order to find more precise asymptotics for pyramid partitions in which one parameter is fixed we connect pyramid partitions to random matrices. Specifically, the Stieltjes-Wigert model is defined and it is shown how the double scaling limits of moments of the Stieltjes-Wigert model completely determines the frozen boundary of pyramid partitions.
    • Intersectional Stigma and Discrimination among Justice-Involved Adults with Co-Occurring Opioid Use and Mental Health Disorder

      Bass, Sarah Bauerle; Zisman-Ilani, Yaara; Stahler, Gerald; Martin, Rosemarie Ann; Khanna, Aditya (Temple University. Libraries, 2024-05)
      Background. Justice-involved adults with co-occurring opioid use disorder (OUD) and mental health disorder (MHD) have complex health needs and underutilize healthcare services and evidence-based interventions to decrease fatal overdose risk, improve mental health symptoms and functioning, and reduce recidivism rates. Stigma and discrimination are commonly cited obstacles to healthcare access and community participation. Combined experiences of criminal-legal system involvements and co-occurring disorders are additionally influenced by other facets of identity and social group memberships, justifying use of an intersectional lens in understanding stigma and discrimination experiences and impacts in this population. However, valid and reliable instruments of intersectional stigma and discrimination have not yet been developed and psychometrically tested among justice-involved adults with co-occurring OUD and MHD. Objective. The objectives of this study were threefold and are presented as three manuscripts. First, a multidimensional measure of intersectional internalized stigma was developed and evaluated among justice-involved adults with co-occurring OUD and MHD (Manuscript 1). Next, the study psychometrically evaluated a recently created measure of intersectional discrimination and examined related health impacts, including psychological distress, active concealment/intentional non-disclosure, and health-related quality of life (Manuscript 2). Finally, internalized stigma, social support, and recovery capital were investigated as potential mediators and moderators of associations between intersectional discrimination and health impacts (Manuscript 3). Methods. Using a cross-sectional survey design, N=213 participants were recruited from community-based settings (e.g., street outreach, harm reduction organizations, treatment clinics, re-entry programs, community resource fairs) from August 2023 to January 2024. Eligible participants completed thirteen survey modules on sociodemographic characteristics, intersectional stigma and discrimination, personal and interpersonal support mechanisms, and health impacts (i.e., psychological distress, active concealment/intentional non-disclosure, and health-related quality of life). Analytic methods included item reduction techniques, structural equation modeling, and mediation/moderation analyses. Conclusion. Results help advance the field of intersectional quantitative stigma and discrimination measurement sciences, elucidate health impacts of intersectional stigma and discrimination among justice-involved people with co-occurring disorders, and identify specific opportunities for empowerment-based resources and interventions to help mitigate the negative health impacts of intersectional stigma and discrimination – such as programs to promote recovery capital and social support (e.g., peer recovery programs and recovery-friendly workplaces).
    • The impact of digital technologies in improving supply chain resilience: An exploratory study in the agri-food industry

      Blessley, Misty P.; Kumar, Subodha; Wray, Matt, 1964-; Mudambi, Susan (Temple University. Libraries, 2024-05)
      Globalization, geopolitics, and socio-economic uncertainties increase supply chain vulnerabilities. Climate changes, natural disasters, and man-made accidents have increased the tension of disturbances. The COVID-19 pandemic has disrupted many supply chains worldwide, putting the agri-food supply chain at a higher risk than ever. Agri-food supply chains face severe and complex challenges due to industry-specific characteristics, such as perishability, short shelf life, long lead time production, and weather dependence. Consumer awareness of having healthy, traceable, and environmentally friendly food products has become an increasing concern, making sustainable development also a vital factor in the agri-food industry. To ensure sustainable development, firms must improve supply chain resilience by discovering, nurturing, and developing resilience capability and competitive advantage. Resilience describes the ability to respond quickly to disruptions and help the supply chain recover. Recently, digital technologies have developed rapidly, supported by the Industrial Revolution 4.0, which plays a crucial role in a company's operations. Digital technologies help promote core resilience competencies such as visibility, collaboration, and agility through typical technologies such as blockchain, artificial intelligence, fifth-generation technology, big data analytics, additive manufacturing, tracking, tracing technologies, etc. This study uses a theoretical framework from dynamic capabilities and extant literature reviews to determine the research gap in the agri-food industry. The study uses mixed methods: a qualitative research method to examine and uncover the role of supply chain resilience in responding to disruptions in the agri-food industry, and a second study used a quantitative method to examine the influence of digital technologies on resilience in the agri-food supply chain. This study confirms the critical role of resilience in the agri-food supply chain and the significance of digital technologies in improving supply chain resilience and firm performance. The study also suggests that a firm should proactively build its resilience capability rather than learn from past disruptions. The findings are useful for academics and practitioners alike, in the acknowledgment of the significant effects of digital technologies on supply chain resilience in the agri-food industry. Some technologies are not agri-food specific but have a place in the industry, while others are tailor made for farming applications. Parties in the agri-food industry must take advantage of Industrial Revolution 4.0 and digital technologies to flourish in the agri-food industry.

      Jones, Resa M.; Dumenci, Levent; Ragin, Camille; Ashing, Kimlin Tam; Cobran, Ewan (Temple University. Libraries, 2024-05)
      Background and PurposeGlobally and in the United States (US), colorectal cancer (CRC) is the second leading cause of cancer-related death, following lung cancer. In addition, there are established racial disparities in incidence and mortality for this disease, where ethnic minority groups have higher incidence and mortality rates. Blacks currently have the second-highest rates of CRC incidence and mortality, are diagnosed at more advanced stages, and have the lowest 5-year survival rates of all racial groups. Multiple influences impact this disparity including area- and individual-level factors. Area-level factors, encompassing social determinants of health (e.g. area-level poverty, housing characteristics, etc.), play a role in disease etiology and outcomes. In addition, timely CRC screening (CRCS) reduces CRC incidence and mortality; however, screening patterns, globally and in the US, are not optimal and differ by race, with ethnic minority groups having low CRCS adherence compared to non-Hispanic whites. Differences in CRCS behaviors and outcomes have been noted for Blacks, a term used to describe, for example, a heterogeneous racial group comprised of US-born Blacks and immigrants from Africa and the Caribbean. While CRCS barriers are well documented for the general population, CRCS barriers are less understood for Blacks and very little is known about CRCS habits and CRCS barriers within this heterogeneous racial group, with limited research including Caribbean immigrants and no known research including African-born immigrants. This dissertation uses a mixed-methods approach to describe CRC incidence, advanced stage at diagnosis, and mortality, CRCS behaviors, and CRCS barriers within the heterogeneous Black population in Philadelphia County, Pennsylvania. Aim 1. Assess colorectal cancer incidence, advanced stage at diagnosis, and colorectal cancer mortality, overall and among individuals who identify as Black/African American, and contextual disparities in Philadelphia County utilizing data from the Pennsylvania State Cancer Registry (2010–2016) and relevant US Census and American Community Survey data. Aim 2. Determine colorectal cancer screening adherence for Cancer Prevention Project of Philadelphia (CAP3) participants who self-identify as Black. Aim 3: Conduct gender-specific focus groups to elucidate the principal barriers to colorectal cancer screening adherence within an average-risk group of adults, ages 45–75, who self-identify as Black or African American, in an urban population. Methods Aim 1. Using an ecological design, descriptive, geographic spatial clustering and hierarchical logistic regression analyses were done to describe CRC incidence, advanced stage at diagnosis, and colorectal cancer-specific mortality in Philadelphia County at the individual- and area-level. CRC incidence, stage at diagnosis, and mortality data for histologically confirmed CRC cases were obtained from the Pennsylvania Cancer Registry from 2010 to 2016, with mortality data including deaths through 2020. Area-level data were retrieved from the US Census Bureau, American Community Survey, etc. Individual- and area-level descriptive characteristics were calculated for all CRC incident cases, cases diagnosed at advanced stage, and colorectal cancer-specific mortality, overall and for whites and Blacks. Geographic clusters with higher-than-expected relative risk for each outcome of interest at the census tract level (HRCT) were identified and individual- and area-level descriptive statistics were calculated for Blacks, overall and by HRCT status. Adjusted hierarchical logistic regression analyses using backward stepwise elimination with model quasi-information criterion was performed to identify potential predictors of HRCTs for CRC incidence and advanced stage at diagnosis. Aim 2. Cross-sectional data from age-eligible adults, 50–75 years (N=357) participating in the ongoing CAP3 study was used to measure CRCS prevalence and adherence and region of birth (e.g., Caribbean-, African-, US-born). Prevalence and adherence were based on contemporaneous US Preventive Services Task Force guidelines. Descriptive statistics and adjusted prevalence and adherence proportions were calculated by region of birth. Adjusted logistic regression models were performed to assess the association between region of birth and overall CRCS and modality-specific adherence. Aim 3. To assess CRCS barriers, we conducted six sex-specific focus groups (n=3 female, n=3 male) with individuals, ages 45-75, who self-identified as Black (i.e., US-, Caribbean, or African-born) and were. Focus groups were held in person and via Zoom, recorded and transcribed verbatim. Codes were developed using coding consensus, co-occurrence, and comparison and open, axial, and selective coding rooted in grounded theory. Dedoose was used to determine CRCS barrier themes as well as general and modality-specific barriers by sex and by region of birth. Results Aim 1. In Philadelphia County, there were 4,641 CRC incident cases, of which 2,086 (44.9%) were non-Hispanic Black (NHB), and 2,555 (53.1%) were white. Mean age at diagnosis for CRC incidence (65.0 vs. 68.9 years), advanced stage at diagnosis (63.2 vs. 67.4 years), and colorectal cancer-specific mortality (67.5 vs. 71.7 years) was lower for Blacks compared to whites (p-value<0.001). Blacks were also diagnosed at a more advanced stage (25.0% vs. 22.4%, p-value=0.038) or unknown stage (8.01% vs. 5.64%, p-value=0.001). For each outcome, when compared to whites, higher proportions of Blacks lived in areas with higher proportions of markers of low socio-economic status and lower proportions of CRCS adherence. Geographic clusters at a higher-than-expected risk of CRC incidence were found in Northeast Philadelphia, North Philadelphia, West Philadelphia, and Southwest Philadelphia. Geographic clusters at a higher-than-expected risk of CRC diagnosed at an advanced stage and colorectal cancer-specific mortality overlapped and were in the North, Kensington, and Southwest neighborhoods of Philadelphia. Area-level NHB, the primary independent variable of interest, reduced the odds of HRCT for CRC incidence (OR: 0.971, 95% CI: 0.960, 0.983) and was not significantly associated with HRCT for advanced stage at diagnosis. In addition, after adjustment, for every one-unit increase in the percent of area-level foreign-born Blacks, there was 1.17-increased odds of being a HRCT for CRC incidence (95% CI: 1.07, 1.28). Similarly, there was a significant positive association with area-level foreign-born Black and being in a HRCT for advanced stage at diagnosis (OR: 1.15, 95% CI: 1.05, 1.26). Other area-level variables that were associated with HRCT for CRC incidence were median rent, percent of mortgaged housing units, and per capita income, which reduced the odds of being a HRCT; Percent of mortgaged housing units also reduced the odds of being a HRCT for advanced stage at diagnosis. Further, CRCS adherence reduced the odds of being a HRCT for advanced stage at diagnosis by approximately 15% (OR: 0.849, 95% CI: 0.791, 0.911). Aim 2. Respondents were 69.5% female, 43.3% married/living with a partner, and 38.4% had <$25,000 annual income. Overall, 78.2% reported past CRCS; however, stool test had the lowest prevalence overall (34.6%). Caribbean (95.0%) and African immigrants (90.2%) had a higher prevalence of overall CRCS compared to US-born Blacks (59.2%) (p-value <0.001). African immigrants were five times more likely to adhere to overall CRCS than US-born Blacks (OR: 5.25, 95% CI: 1.34, 20.6). Immigrants had higher odds of being adherent to colonoscopy (Caribbean=OR: 6.84, 95% CI: 1.49, 31.5; African =OR: 7.15, 95% CI: 1.27, 40.3) compared to US-born Blacks. Aim 3. The majority of focus group participants were 60–64 years old and 72% were immigrants (41% African-born, 31% Caribbean-born). Most participants had had CRCS, but 45% were non-adherent to national CRCS guidelines. Overall, lack of knowledge/awareness, fear, and a sense of feeling healthy and subsequently not seeing the need for CRCS emerged as overarching themes to CRCS barriers. General barriers differed by gender: for women lack of physician recommendation or explanation of CRCS was important and for men not knowing anyone with a history of CRCS was commonly cited. .” Differences in modality-specific barriers by gender were also noted. Barriers also differed by region of birth. US-born Blacks described lack of community advocacy promoting CRC and CRCS awareness as a barrier. African-born Blacks expressed lack of routine CRCS and utilization of preventive medicine in their native country as barriers. US- and Caribbean-born Black males, communicated that discussing CRCS was taboo, which was tied to hegemonic masculinity leading to a lack of conversations about CRC and CRCS. The use of traditional home remedies emerged as a barrier given respondents felt these remedies would aid in preventing CRC thereby reducing the need for CRCS. Immigrant Blacks also described limited insurance coverage due to their citizenship status. Conclusions This dissertation provides the first known insight into various outcomes across the colorectal cancer continuum for the heterogeneous Black population including the growing immigrant Black subgroups in Philadelphia County. To reduce CRC incidence and mortality, interventions and resources to increase CRCS uptake need to target geographic locations with higher percentages of foreign-born Blacks, lower CRCS adherence, and areas with worse socio-economic markers. Also, while Black immigrants had higher CRCS adherence compared to US-born Blacks, CRCS is still sub-optimal in the Black population. Further, CRCS barriers exist and differ by gender, and importantly, there are nuanced barriers by region of birth. Thus, efforts to increase CRCS should address the common and unique barriers and promote stool-based testing, as stool test adherence was low and focus group participants were unfamiliar with this modality as it is not widely promoted or available in clinical practice. In short, these findings across the colorectal cancer continuum should be taken into account for resource allocation and when designing targeted or tailored interventions to promote CRCS uptake for the heterogeneous Black population, which would reduce CRC incidence, late-stage diagnosis, and mortality.
    • The Economic Disadvantages of Asian Immigrants: Credentialism or Disparities in Human Capital?

      Goyette, Kimberly A.; Klugman, Joshua; Bachmeier, James D.; Sanfelice, Viviane (Temple University. Libraries, 2024-05)
      This dissertation examines whether a degree earned abroad is less valuable for Asianimmigrants in the U.S. labor market than for White immigrants and, if so, the reasons for such disparities. Many studies have documented the existence of a foreign education penalty. However, the underlying mechanisms for the lower returns to foreign education are still being determined. Building on the demographic heterogeneity framework, this study aims to advance our understanding of immigrants’ experience in the labor market by investigating whether the lower earnings returns for Asian immigrants with foreign education stem from lower educational quality/transferability, as suggested by the human capital approach, or from biased practices in the labor market, as proposed by credentialism. Methodologically, this study will compare the earnings outcomes of Asian immigrants to those of U.S.-born Whites as well as foreign-educated white immigrants. Using ACS data from 2015-2019 on White and Asian workers aged 25-64 with bachelor’s degrees or higher, I analyze the impact of STEM majors and the English-speaking proficiency of the sending country to explore the effect of human capital transferability. Then, I examine the effect of a country’s GDP per capita and the rates of tertiary education to capture the effect of educational quality. To access credentialism, I compare the earnings differences for Asian immigrants who earn degrees in regions more culturally or historically similar to the U.S. to those degrees earned in other regions. Then, I examine the residual earnings difference between foreign-educated White and Asian immigrants to access queuing theory. Finally, I separate the study population into subsamples of men and women to investigate whether Asian immigrants’ labor market disadvantages are contingent on gender. Chapter 2 to 5 can be read as a stand-alone study that uses nationally representative survey data to study the aspects listed above. Results from these analyses show that the earnings disadvantage of Asian immigrants educated in foreign countries is largely due to the limited transferability of their human capital in the U.S. labor market rather than to credentialism. Returns to foreign education are higher for immigrants with STEM degrees or from countries where English is an official language. In addition to the human capital transferability, this study also shows that White immigrants seem to have an advantage over Asian immigrants if they were educated in places with longer linguistic and cultural differences compared to the United States. In addition, my findings support the explanation that female immigrants’ varied family experiences and migration paths are different from those of their male counterparts, thus leading to their notable disadvantages in the labor markets. The results indicate that establishing clear and transparent processes for recognizing foreign academic and professional credentials is a critical way to alleviate the lower returns on Asian immigrants’ foreign credentials.
    • Neural Coding of Episodic and Spatial Representations in Development

      Newcombe, Nora; Olson, Ingrid R.; Murty, Vishnu P.; Chein, Jason M.; Olino, Thomas; Epstein, Russell A. (Temple University. Libraries, 2024-05)
      Navigation and episodic memory are both fundamental cognitive processes that rely on the hippocampus and its connections to other cortical areas. However, the extent and nature of their interdependence is unclear. We investigated how they relate by testing children (8-13 years, i.e., over the age at which skills are refined towards adult levels) and young adults using a real-world encoding experience, and multiple tests of spatial and episodic memory. We found that the measures formed two latent factors. The memory structure factor included measures that require simultaneously representing all or part of the environment (finding routes, mapping the space, free recall of the experience, and spatial-temporal recognition). The perceptual/factual/locale factor included perceptual and semantic recognition along with JRD (which taxes egocentric and allocentric navigation). Univariate BOLD analysis identified a neural architecture that supports representations across both factors: right hippocampus (HC), lateral occipital area (LO), and entorhinal (ERC), perirhinal (PRC), and parahippocampal (PHC) cortices. Pattern analysis revealed that stable similarity of encoded representations in the anterior right HC related to better performance on the memory structure factor. Stable differentiation of encoded representations in the ERC related to better performance for both factors. Additionally, we found a developmental timeline that extends into early adolescence for spatial representations in the ERC and PRC and for stability of encoded information in the LO. In sum, we found that episodic memory and spatial representations are intertwined in the real world, in which humans seldom operate only spatially or only episodically.

      Dragut, Eduard Constantin; Vucetic, Slobodan; MacNeil, Stephen; Meng, Weiyi (Temple University. Libraries, 2024-05)
      An important means for disseminating information on social media platforms is by including URLs that point to external sources in user posts. In X, formally known as Twitter, we estimate that about 21% of the daily stream of English-language posts contain URLs. Given this prevalence, we assert that studying URLs in social media holds significant importance as they play a pivotal part in shaping the flow of information and influencing user behavior. Examining hyperlinked posts can help us gain valuable insights into online discourse and detect emerging trends. The first aspect of our analysis is the study of users' intentions behind including URLs in social media posts. We argue that gaining insights about the users' motivations for posting with URLs has multiple applications, including the appropriate treatment and processing of these posts in other tasks. Hence, we build a comprehensive taxonomy containing the various intentions behind sharing URLs on social media. In addition, we explore the labeling of intentions via the use of crowdsourcing. In addition to the intentions aspect of hyperlinked posts, we analyze their structure relative to the content of the web documents pointed to by the URLs. Hence, we define, and analyze the segmentation problem of hyperlinked posts and develop an effective algorithm to solve it. We show that our solution can benefit sentiment analysis on social media. In the final aspect of our analysis, we investigate the emergence of news outlets posing as local sources, known as "pink slime", and their spread on social media. We conduct a comprehensive study investigating hyperlinked posts featuring pink slime websites. Through our analysis of the patterns and origins of posts, we discover and extract syntactical features and utilize them for developing a classification approach to detect such posts. Our approach has achieved an accuracy rate of 92.5%.

      Confredo, Deborah A.; Dilworth, Rollo A.; Hall, Suzanne; Klein, Michael Leslie (Temple University. Libraries, 2024-05)
      Creating cross-cultural understanding amongst students and incorporating music from various cultures around the world has become essential in the field of music education, but still has a long way to go to become more mainstream. The incorporation of world music in teacher preparation programs and music classrooms varies greatly. While many researchers have studied these elements separately, very little research exists on the connection between the type of music teacher preparation, performance life outside the classroom, and world music experiences a teacher creates in the curriculum. The purpose of this mixed methods study was to examine the relationship between: type of music teacher preparation, performance life outside of school, and world music experiences an individual teacher incorporates into their curriculum. This study used the sequential explanatory design model using a survey instrument (n=11) and participant interviews (n=9). Specifically, participants included secondary general music teachers working in Quaker schools in the United States with at least a bachelor's degree in music education. Quaker educators were included due to the population’s virtual exclusion from all current literature as well as their progressive outlook on education and inclusivity. Findings suggest that Quaker educators overwhelmingly have a desire to teach music from various cultures and utilize it in their classrooms mostly from professional development opportunities, despite their overall lack of training during their undergraduate coursework. While generalizable findings were difficult to explain due to a low number of participants in the survey, the qualitative interview data sheds a unique outlook on Quaker school teacher background and experience with world music. Implications for the field of music education and further research opportunities are also discussed.
    • Perceived Effectiveness Of Diversity Management Initiatives: After The Black Lives Matter Movement Of 2019

      Wray, Matt, 1964-; Tesfai, Rebbeca; Blau, Gary J.; Di Benedetto, C. Anthony (Temple University. Libraries, 2024-05)
      Corporations closely monitor social change to assess potential risks to their strategic objectives. As seen in the social unrest of 2019, their reliance on diversity initiatives demonstrated their solidarity. Such efforts, heightened by stakeholder influence can obscure the attitudes and perceptions of those they most rely upon to carry out these policies. While corporate leaders set these initiatives, managers implement and oversee them. This dissertation explores managerial attitudes and perceptions toward diversity management initiatives. It benchmarks this endeavor through two studies. Study 1 establishes the groundwork for this investigation by building a theoretical framework and identifying a research gap concerning the need for validated Diversity Management Initiatives (DMI) scales. Study 2 methodologically develops novel DMI measurements and assesses the current state of managers’ demeanors toward diversity mechanisms. This research provides valuable, scholarly insights into diversity management's contemporary, shifting landscape.