Animal testing is a long-running institution in biomedical research that is seen as a necessary step in the development of new drugs and treatments in the United States. Using animal models that have biological similarities to humans, it is assumed that we can ethically perform basic research that is translatable to human health. However, recent years have seen this assumption challenged by the fact that most preclinical research fails to survive the gauntlet of human trials into a functioning treatment on the market. This has marked ethical implications for both the people that depend on new treatments for their health, and the animals used in the research themselves. The purpose of this thesis is to develop solutions for the problems facing animal testing in the United States. First, I identify the political and economic basis of the modern system of animal testing by examining legislation and the IACUCs that govern animal research to understand why the practice continues to be used despite its low rate of success. I then examine factors such as epigenetics and the laboratory environment to explain reasons why animal research fails to translate to humans. Finally, I cover new in-vitro methods such as organoids and organ-on-a-chip technologies to show the potential that alternatives hold for biomedical research. As a result of this analysis, I propose the further integration of alternatives into our system of animal testing to make up for the translational failures the field currently experiences. I also highlight the importance of having IACUCs balanced between animal researchers and members of the public to improve the welfare of animals used in research and increase the transparency of their work. Including more animals into the Animal Welfare Act is also proposed to better standardize our treatment of them and keep experimental results more consistent.

Yuma County, a primarily agricultural community on the border of Mexico and Arizona, has been deemed a “medical island surrounded by a sea of sand.”17 Yuma, Arizona consists of over 200,000 people, with an additional 80,000 to 100,000 winter visitors.17 An extra 41,000 farm workers from California and 50,000 Mexicans on work visas travel to Yuma during the winter harvest season.17 Additionally, approximately 20% of residents live below the poverty line and 60% of the population is Hispanic in 2016.17 Unemployment in Yuma is also 50% higher than the national average, and has a 20% unemployment rate in 2016.17 Because these statistics are higher than the state and national averages, the Department of Health and Human Services have declared Yuma County as a “high needs area.”17 For all of these residents in Yuma County, Yuma Regional Medical Center is the sole healthcare provider.

In the last 200 years, advancements in science and technology have made understanding female sexual function and the female body more feasible; however, many women throughout the US still lack fundamental understanding of the reproductive system in the twenty-first century. Many factors contribute to the lack of knowledge and misconceptions that women still have. Discussing sexual health tends to make some people uncomfortable and this study aims to investigate what aspects of somewhat recent US history in women’s health care may have led to that discomfort. This thesis examines the question: what are some of the factors that shaped women’s reproductive medicine in the US from the mid 1800s and throughout the 1900s and what influence could the past have had on how women and their physicians understand female sexuality in medicine and how physicians diagnose their female patients in the twenty-first century. A literature review of primary source medical texts written at the end of the 1800s provides insight about patterns among physicians at the time and their medical practice with female patients. Factors like gendered expectations in medical practice, misconceptions about the female body and behaviors, and issues of morality in sex medicine all contributed to women lacking understanding of sex female reproductive functions. Other factors like a physician’s role throughout history and non-medical reproductive health providers and solutions likely also influenced the reproductive medicine women received. Examining the patterns of the past provides some insight into some of the outdated and gendered practices still exhibited in healthcare. Expanding sexual education programs, encouraging discussion about sex and reproductive health, and checking gendered implicit bias in reproductive healthcare could help eliminate echoes of hysteria ideology in the twenty-first century medicine.

Since the Acquired Immune Deficiency Syndrome (AIDS) crisis began in the early 1980s, there has been a significant amount of stigma attached to the disease and the virus that causes it, Human Immunodeficiency Virus (HIV). At the time, HIV/AIDS was viewed as a death sentence. A large part of the stigma came from the fact that in the early days of the crisis, AIDS patients were predominantly part of the LGBTQ+ community. With the discovery of effective antiretroviral therapies, today HIV can be thought of as a preventable, yet manageable, chronic illness, although it remains a huge public health concern (About HIV/AIDS, 2018). While the virus is now rarely viewed as a death sentence, there is still considerable stigma that surrounds people living with HIV/AIDS (PLWHA). Research shows that the shows and movies people watch can affect their attitudes on a variety of issues, and HIV is no exception. Because HIV is such a big threat to public health, and because people often adopt views they see in media, analyzing the ways shows and movies portray PLWHA is an important aspect in understanding where stigma surrounding HIV/AIDS comes from. The writers behind today's HIV+ characters on television and in movies all seemingly made an effort to decrease stigma, but they went about it in different ways, and with varying amounts of success. A common method to dispel stigma was to use the entertainment-education method (Singhal & Rogers, 1999), which in these cases means characters had discussions about topics like safe sex, Pre-Exposure Prophylaxis (PrEP), and the importance of getting tested. A few shows showed serodiscordant couples, which was also effective at fighting stigma. In contrast, by trying to be representative of PLWHA, some shows actually contributed to the stereotypes behind the stigma, or had characters be openly stigmatizing towards PLWHA. After analyzing what I found the shows and movies did well and what they did poorly, I'll analyze why it is important that shows maintained historical accuracy, and how doing so appeared to fight the stigma associated with HIV/AIDS. I will also evaluate what's missing \u2014 such as which high-risk groups are not represented. Ultimately, this thesis will argue that shows and movies made in the last 12 years all aimed to decrease stigma, through a variety of techniques.

Twilight Sleep was a technique originally developed by physicians in Germany in the early 20th century as a novel way to address parturient women’s fear and aversion to pain endured during labor and childbirth. Using a combination of amnestic and analgesic agents such as scopolamine and morphine to synergistically suppress pregnant women’s memories, physicians Carl Gauss and Bernhard Krönig enabled women to give birth free of pain, or more accurately any memories of pain.

Despite widespread use throughout Europe, Twilight Sleep initially experienced less popularity and more resistance in the United States where doctors were wary of the potential health risks that Twilight Sleep brought upon women and infants. Some adverse effects caused by incorrect doses of scopolamine and morphine included hallucinations and uncontrolled thrashing in women and depressed respiration in infants. Thus, Twilight Sleep’s status as a vogue topic in obstetrics during the first half of the 20th century came about due to the work of affluent and educated American women. While lacking formal medical training, a subset of women became experts in the matter of Twilight Sleep by traveling to Germany to experience and investigate Twilight Sleep firsthand then disseminating their findings through published books and articles.

This thesis explores the impact of Twilight Sleep on women and physicians and their perceptions of childbirth. Twilight Sleep empowered women to take on a more active role in shaping the medical care they received rather than accepting that childbirth as a natural event associated with physical and mental trauma and high risk of mortality. For doctors, the debate regarding Twilight Sleep’s safety and efficacy affirmed a ubiquitous notion that childbirth ought to be seen as a pathological rather than natural event. By considering childbirth a medical condition that necessitated treatment, physicians had to evaluate their duties to their patients. In empowering women to be involved in making medical decisions and forcing physicians to balance their medical training with their patients’ needs, Twilight Sleep helped to establishing more reciprocal doctor-patient relationships.

Popular Culture of today, particularly books and movies have begun to influence the way individ- uals and society as a whole, views specific concepts. In this case, the fairly recent phenomenon of the Sci- ence Fiction Drug Niche has produced significant thought among audiences as to both the benefits and costs of cognitive enhancers in our world. Through the use of both a thorough analysis of modern films and novels on the topic as well as focus groups of the average college students this study analyzes the influence that this niche has had on the perceptions that students have towards the use of such cognitive enhancements. Small groups of students were shown the same film: Limitless, and discussion after the film displayed the students thoughts and attitudes towards the ideas shown in the film. Limitless itself falls into this Science Fiction drug niche and discusses both benefits and harms of chemical cognitive enhancement. The study indicates that audiences have thought not only about the issues that may arise with the presence of cognitive enhancement in our world but also the possible benefits of this enhancement. The results go even further to preliminarily show that there are common thoughts that arise in such situations. These common ideas that arise show, at least on a very basic level, that the presence of these Science Fiction Drug-inspired works are influencing the way audiences perceive the use of cognitive enhancement as well as influencing what doubts, questions, hopes, and fears arise from these pharmaceuticals. This preliminary study could use further research to ana- lyze the effects of popular culture on perceptions of cognitive enhancement and pharmaceuticals to alter consciousness.

Telestroke networks reduce disparities in acute stroke care between metropolitan primary stroke centers and remote hospitals. Current technologies used to conduct remote patient assessments have very high start-up costs, yet they cannot consistently establish quality connection in a timely manner. Smartphgones can be used for high quality video teleconferencing (HQ-VTC). They are relatively inexpensive and widley used among healthcare providers. We aimed to study the reliability of HQ-VTC using smartphones for conducting the NIHSS. Two vascular neurologists (VNs) assessed 83 stroke patients with the NIHSS. The remote VN assessed patients using videoconferencing on a smartphone with the assistance of a bedside medical aide. The bedside VN rated patients ontemporaneously. Each VN was blinded to the other's NIHSS scores. We tested the inter-method agreement and physician satisfaction with the device. We demonstrated high total NIHSS score correlation between the methods (r=0.941, p<0.001). The mean total NIHSS scores for bedside and remote assessments were 7.3 plus or minus 7.9 and 6.7 plus or minus 7.6 with ranges of 0-30 and 0-37, respectively. Seven NIHSS categories had significantly high agreement beyond chance: LOC-questions, LOC-commands, visual fields, motor left arm, motor right arm, motor left leg, motor right leg; seven categories had moderate agreement: LOC-consciousness, best gaze, facial palsy, sensory, best language, dysarthria, extinction/inattention; one category had poor agreement: ataxia. There was high physician satisfaction with the device. The VNs rated 96% of the assessments as good or very good for "image quality," "sound quality," "ease of use," and "ability to assess subject using NIHSS," and 84% of the assesssments as good or very good for "reception in hospital." The smartphones with HQ-VTC is reliable, easy to use, and affordable for telestroke NIHSS administration. This device has high physician satisfaction. With the variety of smartphones and professional medical applications available today, the telestroke practitioner has all the tools necessary for fast clinical decision-makingby accessing electronic medial records, viewing images, and tracking patient vitals.

Science fiction works can reflect the relationship between science and society by telling a story set in the future of ethical implications or social consequences of scientific advancement. This thesis investigated how the concept of reproduction is depicted in popular science fiction works. I reviewed and analyzed four popular science fiction works that all showed fear over the government controlling our choices in reproductive technology. The analysis of my thesis can be used as a way to understand how we view the ideas and the consequences of reproductive technology through concepts of reproduction. These perspectives and ideas as a reflection of society's concerns as we discuss the future of the ethics and politics of reproductive technology and reproductive issues.

The concept of “good” research is concrete in terms of technique, but complex in theory. As technology advances, the complexity of problems we must solve also grows. Research is facing an ethical dilemma—which projects, applied or basic, should be funded. Research is no longer an isolated sector in society, and the decisions made inside of the laboratory are affecting the general public more directly than ever before. While there is no correct answer to what the future of research should be, it is clear that good research can no longer be only defined by the current classification system, which is rooted in antiquated, yet ingrained, social status distinctions.
Differences between basic and applied research were explored through a wet-lab case study. Vaccinia virus (VACV) infections are a prime model of the competition between a virus and its host. VACV contains a gene that is highly evasive of the host immune system, gene E3L. The protein encoded by E3L is E3, which contains two highly conserved regions, a C-terminus, and a N-terminus. While the C-terminus is well-understood, the mechanism by which the N-terminus grants IFN resistance was previously unknown. This project demonstrated that the N-terminus prevents the initiation of programmed necrosis through host-encoded cellular proteins RIP3 and DAI. These findings provide insight into the function of the N-terminus of E3, as well as the unique functions of induced programmed necrosis.
This project was an example of “basic” research. However, it highlights the interconnectivity of basic and applied research and the danger in isolating both projects and perspectives. It points to the difficult decisions that must be made in science, and the need for a better research classification system that considers what makes science “good” outside of antiquated social class ideologies that have shaped science since ancient Greece. While there are no easy answers to determine what makes research “good,” thinking critically about the types of research projects that will be pursued, and the effects that research has on both science and society, will raise awareness, initiate new conversations, and encourage more dialogue about science in the 21st century.

Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder that is becoming increasingly common. Autism does not yet have a known etiology, nor a definitive diagnostic test, thus making diagnosis a difficult and rarely uniform task. Currently, ASD is behaviorally diagnosed based on criteria defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Recently, a change was made in the criteria from more lenient criteria in DSM-IV-TR, to more narrow criteria laid out by the DSM-V, which supersedes the DSM-IV-TR. This drastic change raised many questions and debates about which set of criteria are better. The more lenient criteria offers a more inclusive diagnosis giving greater access to therapies; while the narrow diagnostic criteria excludes some individuals, creating a more uniform diagnosis that's easier to use in research. This thesis analyzes the change in diagnostic criteria from the DSM-IV-TR to the DSM-V and the effects of these changes on the practices of diagnosis. In addition, it explores the implications of this change for the families of children with autism and for those involved in autism research, examining their respective opinions and interests pertaining to narrow verses broad diagnostic criteria. Building on this analysis, the thesis offers recommendations about diagnostic criteria should be set. It argues that the wellbeing of patients takes priority over the interests of researchers, and thus diagnosis should be done in a way that offers the best prognosis for all children who suffer from autistic symptoms.