In the US, menstrual education, which provides key information about menstrual hygiene and health to both young girls and boys, historically lacks biologically accurate information about the menstrual cycle and perpetuates harmful perceptions about female reproductive health. When people are unable to differentiate between normal and abnormal menstrual bleeding, based on a lack of quality menstrual education, common gynecological conditions often remain underreported. This raises a question as to how girls’ menstrual education experiences influence the ways in which they perceive normal menstrual bleeding and seek treatment for common abnormalities, such as heavy, painful, or irregular menstrual bleeding. A mixed methods approach allowed evaluation of girls’ abilities to recognize abnormal menstrual bleeding. A literature review established relevant historical and social context on the prevalence and quality of menstrual education in the US. Then, five focus groups, each including five to eight college-aged women, totaling thirty-three participants, allowed for macro-level analysis of current challenges and gaps in knowledge related to menstruation. To better examine the relationship between menstrual education and reproductive health outcomes, twelve semi-structured, one-on-one interviews allowed micro-level analysis. Those interviews consisted of women diagnosed with endometriosis and polycystic ovary syndrome, common gynecological conditions that include abnormal menstrual bleeding. Developing a codebook of definitions and exemplars of significant text segments and applying it to the collected data revealed several themes. For example, mothers, friends, teachers, the Internet, and social media are among the most common sources of information about menstrual hygiene and health. Yet, women reported that those sources of information often echoed stigmatized ideas about menstruation, eliciting feelings of shame and fear. That poor quality of information was instrumental to women’s abilities to detect and report abnormal menstrual bleeding. Women desire and need biologically accurate information about reproductive health, including menstruation and ovulation, fertility, and methods of birth control as treatments for abnormal menstrual bleeding. Unfortunately, menstrual education often leaves girls ill-equipped to identify and seek treatment for common gynecological conditions. Those findings may influence current menstrual education, incorporating biological information and actively dismissing common misconceptions about menstruation that influence stigma.

This thesis reviews the initial cases of fetal surgery to correct myelomeningocele, a severe form of spina bifida, and discusses the human and social dimensions of the procedure. Myelomeningocele is a fetal anomaly that forms from improper closure of the spinal cord and the tissues that surround it. Physicians perform fetal surgery on a developing fetus, while it is in the womb, to mitigate its impacts. Fetal surgery to correct this condition was first performed experimentally in the mid-1990and as of 2020, it is commonly performed. The initial cases illuminated important human and social dimensions of the technique, including physical risks, psychological dimensions, physician bias, and religious convictions, which affect decision-making concerning this fetal surgery. Enduring questions remain in 2020. The driving question for this thesis is: given those human and social dimensions that surround fetal surgery to correct myelomeningocele, whether and when is the surgery justified? This thesis shows that more research is needed to answer or clarify this question.

Prior to the first successful allogeneic organ transplantation in 1954, virtually every attempt at transplanting organs in humans had resulted in death, and understanding the role of the immune mechanisms that induced graft rejection served as one of the biggest obstacles impeding its success. While the eventual achievement of organ transplantation is touted as one of the most important success stories in modern medicine, there still remains a physiological need for immunosuppression in order to make organ transplantation work. One such solution in the field of experimental regenerative medicine is interspecies blastocyst complementation, a means of growing patient-specific human organs within animals. To address the progression of immune-related constraints on organ transplantation, the first part of this thesis contains a historical analysis tracing early transplant motivations and the events that led to the discoveries broadly related to tolerance, rejection, and compatibility. Despite the advancement of those concepts over time, this early history shows that immunosuppression was one of the earliest limiting barriers to successful organ transplantation, and remains one of the most significant technical challenges. Then, the second part of this thesis determines the extent at which interspecies blastocyst complementation could satisfy modern technical limitations of organ transplantation. Demonstrated in 2010, this process involves using human progenitor cells derived from induced pluripotent stem cells (iPSCs) to manipulate an animal blastocyst genetically modified to lack one or more functional genes responsible for the development of the intended organ. Instead of directly modulating the immune response, the use of iPSCs with interspecies blastocyst complementation could theoretically eliminate the need for immunosuppression entirely based on the establishment of tolerance and elimination of rejection, while also satisfying the logistical demands imposed by the national organ shortage. Although the technology will require some further refinement, it remains a promising solution to eliminate the requirement of immunosuppression after an organ transplant.

Clickers are a common part of many classrooms across universities. Despite the widespread use, education researchers disagree about how to best use these tools and about how they impact students. Prior work has shown possible differential impacts of clickers based on demographic indicators, such as age, gender, and ethnicity. To explore these topics a two-part project was designed. First, a literature review was completed focusing on past and current clicker practices and the research surrounding them. Second, original data, stratified by demographic characteristics, was collected on student perceptions of clickers. The literature review revealed that not all uses of clickers are created equal. Instructors in higher education first introduced clickers to enhance traditional pedagogies by simplifying common classroom tasks (e.g. grading, attendance, feedback collection). More recently, instructors pair clickers and novel pedagogies. A review of the identified benefits and drawbacks for students and instructors is provided for both approaches. Instructors can use different combinations of technological competency and pedagogical content knowledge that lead to four main outcomes. When instructors have both technological competency and pedagogical content knowledge, all the involved parties, students and instructors, benefit. When instructors have technological competency but lack pedagogical content knowledge, instructors are the main benefactors. When instructors have pedagogical content knowledge alone, students can benefit, but usefulness to the instructor decreases. When instructors have neither technological competency nor pedagogical content knowledge, no party benefits. Beyond these findings, recommendations are provided for future clicker research. Second, the review highlighted that clickers may have a differential impact on students of different demographic groups. To explore this dynamic, an original study on student views of clickers, which included demographic data, was conducted. The original study does not find significantly different enthusiasm for clickers by demographic group, unlike prior studies that explored some of these relationships. However, white students and male students are overrepresented in the group that does not enjoy clickers. This conclusion is supported by visual observations from the means of the demographic groups. Overall, based on the review of the literature and original research, if instructors pair clickers with validated pedagogies, and if researchers continue to study clicker classrooms, including which students like and benefit from clickers, clickers may continue to be a valuable educational technology.

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.

Access to testing for the human immunodeficiency virus (HIV), as well as other care services related to HIV/AIDS, have greatly improved in Tanzania over the last decade. Despite the country’s efforts to increase the number of individuals who get tested for HIV annually, it is estimated that only 52.2-70.0% of people living with HIV (PLWH) knew their HIV positive status at the end of 2017. In addition, research in Tanzania has shown that HIV-related stigma and discrimination are widespread and contribute to low uptake of HIV testing and non-adherence to antiretroviral treatment (ART). In order to achieve the goals set forth by the Government of Tanzania and the Joint United Nations Programme on HIV/AIDS (UNAIDS), as well as move towards an AIDS-free generation, a deeper understanding of the stigma-related barriers to seeking an HIV test is necessary. This research aims to better understand the relationship between HIV-related stigma and attitudes towards HIV testing among community members in Northern Tanzania. In addition, it looked at the specific barriers that contribute to low uptake of HIV testing, as well as the impact of social networks on an individual’s motivation and willingness to get tested for HIV. In this research, community members in Meru District (N = 108, male = 69.4%, female = 28.7%) were surveyed using various validated instruments that covered a range of topics, including knowledge of HIV/AIDS, testing attitudes, and perceived risk of HIV infection. The mean overall score for correct answers on the knowledge measure was 69.8% (SD = 16.4). There were no significant group differences between individuals who had ever tested and individuals who had not tested in relation to HIV/AIDS knowledge or HIV testing attitudes. The factors that were significantly associated with getting an HIV test were knowing someone who had previously tested (p = 0.003), as well as openly discussing HIV testing within one’s social group (p = 0.017). Participants also provided qualitative responses for barriers to receiving an HIV test, motivations for getting tested, and suggested interventions for improving HIV testing uptake. The goal of this research is to develop recommendations for interventions that are better informed by attitudes and motivations for testing.

This dissertation examines the efforts of the Carnegie Image Tube Committee (CITC), a group created by Vannevar Bush and composed of astronomers and physicists, who sought to develop a photoelectric imaging device, generally called an image tube, to aid astronomical observations. The Carnegie Institution of Washington’s Department of Terrestrial Magnetism coordinated the CITC, but the committee included members from observatories and laboratories across the United States. The CITC, which operated from 1954 to 1976, sought to replace direct photography as the primary means of astronomical imaging.

Physicists, who gained training in electronics during World War II, led the early push for the development of image tubes in astronomy. Vannevar Bush’s concern for scientific prestige led him to form a committee to investigate image tube technology, and postwar federal funding for the sciences helped the CITC sustain development efforts for a decade. During those development years, the CITC acted as a mediator between the astronomical community and the image tube producers but failed to engage astronomers concerning various development paths, resulting in a user group without real buy-in on the final product.

After a decade of development efforts, the CITC designed an image tube, which Radio Corporation of American manufactured, and, with additional funding from the National Science Foundation, the committee distributed to observatories around the world. While excited about the potential of electronic imaging, few astronomers used the Carnegie-developed device regularly. Although the CITC’s efforts did not result in an overwhelming adoption of image tubes by the astronomical community, examining the design, funding, production, and marketing of the Carnegie image tube shows the many and varied processes through which astronomers have acquired new tools. Astronomers’ use of the Carnegie image tube to acquire useful scientific data illustrates factors that contribute to astronomers’ adoption or non-adoption of those new tools.

Emergency Medical Services (EMS) first response personnel treat urgent and immediate

illnesses and injuries in prehospital settings, and transport patients to definitive care if needed. EMS originated during warfare. The practice of rescuing wounded soldiers started during the Byzantine Empire, and developed along with other medical advances to the present day. Civilian EMS in the United States grew rapidly starting in the 1960s. Following the landmark National Research Council white paper of “Accidental Death and Disability: The Neglected Disease of Modern Society”, the nation addressed the key issues and problems faced in delivering emergency medical services. Today, colleges and universities often sponsor EMS organizations to serve populations concentrated in complex campuses. These are collectively known as Collegiate-Based Emergency Medical Services (CBEMS). By September 2018, there were 252 registered CBEMS organizations in the United States. Most are affiliated with the National Collegiate Emergency Medical Services Foundation (NCEMSF), which advocates, encourages, and provides support for CBEMS organizations. A survey repeating prior work (1996 and 2005) was sent to all NCEMSF registered CBEMS organizations, and 24 responded. The survey included questions on demographics, response capacities, coverage, organization, and logistics information. Locally, Arizona State University Student Emergency Medical Services (SEMS at ASU) began as an all-student-run volunteer organization in 2008. In 2018, SEMS at ASU became ASU EMS, as an official subdivision of the ASU Environmental Health Safety (EH&S) Department. This study summarizes the history of EMS, investigates the current status of CBEMS organizations and traces the history of ASU EMS from a volunteer group to an official department.

Advocacy groups work across many aspects of “death with dignity” practice and treatment, and provide insight across multiple aspects of “death with dignity”. This study argues that key advocacy groups in the American death with dignity movement influenced the broader conceptualization of death with dignity in a way that makes patients more able to achieve it. This influence has been a dynamic process across different periods of practice starting the discussion of “death with dignity” in 1985 through today, although this thesis extends only to 2011. The question in this study is how do the three main historical advocacy groups in the US: the Hemlock Society, Compassion in Dying, and Compassion and Choices, conceptualize death with dignity with regards to patient and doctor relationship, legal and policy factors, and medical technologies and protocols? This study found that the Hemlock Society (1980-2005) characterized death with dignity as a terminally ill patient being able to “self-deliver” from suffering via autoeuthanasia regardless of medical community approval or legality. Compassion in Dying (1993-2007) characterized death with dignity as involved advocacy work with terminal patients and their communities to pursue palliative care and hospice up to the point of assisted death. This organization was also involved in the passing of Oregon Death with Dignity Act. Compassion and Choices (2007-present) characterized death with dignity similarly to Compassion in Dying but also advocated for adequate management of pain and suffering symptoms in palliative care to prevent people from desiring death over the illness. Conceptualizing death with dignity is important for understanding why patients want death with dignity and better accommodating their end of life needs when they are suffering with terminal illness.

Cervical cancer, which many physicians of 2019 consider to be a success in terms of establishing widely used forms of early preventative and diagnostic technologies, experienced a reduction in incidence rates in women by over fifty percent between 1975 and 2016. Cervical cancer does not often present in women with symptoms until it has entered a later stage of the disease. Because of this fact, in the early twentieth century, physicians were often only able to diagnose cervical cancer when either the woman reported complaints or there was a visual confirmation of lesions on the cervix. The symptoms women often reported included vague abdominal pain, bleeding after sex, and abnormal amounts of vaginal discharge, all of which are non-specific symptoms, making it even harder for women to be diagnosed with cervical cancer. This thesis answers the following question: How does the history of cervical cancer show that prevention helps reduce rates of cancer-related deaths among women? By studying the history of cervical cancer, people can understand how a cancer that was once one of the top killers of women in the US has declined to become one of the lowest through the establishment of and effective communication of early prevention and diagnostics, both among the general public and within the medical community itself. This thesis is organized based on key episodes which were pertinent to the history of cervical cancer, primarily within the United States and Europe. The episodes are organized in context of the shifts in thought regarding cervical cancer and include topics such as vaccine technologies like the Gardasil and Cervarix vaccines, social awareness movements that educated women on the importance of early detection, and analyses of the early preventative strategies and attempts at treating cervical cancer. After analyzing eleven key episodes, the thesis determined that, through the narrative of early attempts to treat cervical cancer, shifting the societal thought on cancer, evolving the importance of early detection, and, finally, obtaining a means of prevention, the history of cervical cancer does demonstrate that the development of preventative strategies has resulted in reducing cancer-related deaths among women. Understanding what it took for physicians to evolve from simply detecting cervical cancer to being able to prevent it entirely matters because it can change the way we think about managing other forms of cancer.