Digital Commons Network^™

Preconception Phthalate Exposure And Women’S Reproductive Health: Pregnancy, Pregnancy Loss, And Underlying Mechanisms, Carrie J. Nobles, Et. Al.

Environmental Health Sciences Faculty Publication Series

Background:

Objectives:

Methods:

Using Evidence-Based Interventions To Improve The Completion Rates Of Advance Care Directives, Fariba Sohrabi

Doctor of Nursing Practice (DNP) Projects

Background: Advance care directives reduce unnecessary suffering, improve life quality, and further engage patients and families in the decision-making process to ensure that end-of-life care preferences are considered and applied. Despite the proven benefits of advance care directives, advance directives completion rates are approximately 33% in the United States. Purpose: The purpose of this quality improvement project was to increase advance directive completion rates among patients at one clinic through an educational intervention. Methods: The intervention was used to educate patients about the benefits of advance care directives, and present opportunities for patients to complete the directive. The intervention included …

Reactive Chemistries For Protein Labeling, Degradation, And Stimuli Responsive Delivery, Myrat Kurbanov

Doctoral Dissertations

Reactive chemistries for protein chemical modification play an instrumental role in chemical biology, proteomics, and therapeutics. Depending on the application, the selectivity of these modifications can range from precise modification of an amino acid sequence by genetic manipulation of protein expression machinery to a stochastic modification of lysine residues on the protein surface. Ligand-Directed (LD) chemistry is one of the few methods for targeted modification of endogenous proteins without genetic engineering. However, current LD strategies are limited by stringent amino acid selectivity. To bridge this gap, this thesis focuses on the development of highly reactive LD Triggerable Michael Acceptors (LD-TMAcs) …

Chemical Modification And Evaluation Of Cells Towards Use As Delivery Tools, Bishnu Prasad Joshi

Doctoral Dissertations

CHEMICAL MODIFICATION AND EVALUATION OF CELLS TOWARDS USE AS DELIVERY TOOLS SEPTEMBER 2023 BISHNU PRASAD JOSHI M.S., SRI SATHYA SAI INSTITUTE OF HIGHER LEARNING Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Michelle E. Farkas Endogenous cells are being studied for use in various applications, such as next generation therapeutics and drug delivery vehicles. This is on account of their biocompatibility, amenable distribution profiles, and in many instances, recruitment to and localization of diseased tissues. Multiple cell types have been employed, including macrophages, stem cells, red blood cells, and T cells. Most examples of cell-based delivery utilize phagocytosed entities as …

Exploring The Associations Between Sexism, Physical Behaviors, And Psychosocial Correlates Of Physical Activity In Young Women, Melanna Cox

Doctoral Dissertations

Physical behaviors (PB), defined as physical activity (PA) and sedentary behavior (SB), tend to be less favorable in women than in men. Low self-efficacy (SE) and social support (SS), and gender norms hinder women’s PB. Benevolent sexism, a theory on gender norms, could explain the gender disparity. PURPOSE: To 1) assess the associations among benevolent sexism endorsement (BSEN), experiences with benevolent sexism (EBS), PB, SE, and SS, 2) evaluate if BSEN or SE mediate the relationship between EBS and PB, and 3) develop a questionnaire that measures a woman’s sexist experiences in PA. METHODS: Study 1: Women (N=186) completed a …

Impact Of Child/Parent Characteristics On Ultra-Processed Food Intake In Preschool-Aged Children, A Latent Class Analysis Of Obesity-Related Factors And Obesity Risk, And The Qualitative Impact Of 9-11 Year Old's Perception Of Unhealthy Food Marketing, Jennifer E. Carroll

Doctoral Dissertations

Childhood overweight/obesity is an epidemic in the US. Modifiable risk factors, such as intake of foods that are highly processed, are heavily marketed to children. Exposure to food advertisements, along with home environment factors, family meal styles, and digital media habits shapes children’s preferences, tastes, and habits. Predictors of ultra-processed food (UPF) intake in children are unclear and the potential effect of ad exposure on UPF intake is unknown. It is also unknown if there are distinct response patterns among a collection of potentially obesity-related factors, and if distinct groups affect child BMI. Additionally, more qualitative research is needed to …

A Grounded Theory Of Patient Flow Management Within The Emergency Department, Ellen Benjamin

Doctoral Dissertations

Background: Emergency department (ED) crowding is an urgent threat to patient safety and negatively impacts healthcare staff and institutions. Patient flow researchers have employed a range of methods to address this crisis, including an increase in the use of operations research and operations management strategies. However, identified patient flow solutions are inadequate. Research describing the complexities of patient flow processes and investigating the work and contributions of ED nurses is needed. Purposes: The purposes of this study were to explore how ED nurses perform patient flow management and to develop a constructivist grounded theory of patient flow management within the …

The Meanings Of Daily Activities And Attitudes Of Older Breast Cancer Survivors: A Case Study Research, Wadha Alquraini

Doctoral Dissertations

Objectives: The aim of the study was to explore how older breast cancer survivors made meaning from daily activities and their attitudes to life and behaviors in it. Method: Secondary data was analyzed from nine older women with breast cancer. Data on living women was used to elicit the influence of breast cancer on survivors' attitudes and behaviors. Results: Eight significant themes were identified that were related to breast cancer meanings, attitudes to it, and behaviors that impact participants' survivorship; breast cancer means death or being close to death, survivor-provider relationships, social support, the meaning of dignity or …

Head Stabilization And Cortical Activation In Contact Sport Athletes During Walking Under Different Visual Task Constraints, Sam Zeff

Doctoral Dissertations

Contact sport participation exposes athletes to repetitive sub-concussive head impacts, which have been shown to elicit cortical neurophysiologic, cognitive, and motor performance alterations that have the potential to disrupt visual perception. Despite the growing concern regarding sub-concussive impacts, our understanding of their implications on motor performance and risk for further injury is limited. A stable head provides a consistent perceptual platform for the visual and vestibular sensory systems, but the effects of contact sport participation on head stability and visual perception remain poorly understood. The goal of this dissertation was to understand whether contact sport participation modifies athletes’ ability to …

Weight Bias In Pre-Professional Health Students, Heather A. Wemhoener

Doctoral Dissertations

Weight bias includes negative attitudes or judgements towards people in larger bodies. It is associated with poor health outcomes. Weight bias is highly common in the United States, and pre-professional health students are known to exhibit it. Given its impact, finding effective interventions to reduce weight bias is important. The first paper reviewed literature on existing interventions for weight bias reduction. The search revealed three main intervention types: targeting attributions, increasing empathy, and targeting social consensus. Interventions, regardless of strategy, yielded mixed results for weight bias reduction, and, in some cases, increased bias. The second paper tested a novel intervention …

Mining High Impact Combinations Of Conditions From The Medical Expenditure Panel Survey, Arjun Mohan

Masters Theses

The condition of multimorbidity — the presence of two or more medical conditions in an individual — is a growing phenomenon worldwide. In the United States, multimorbid patients represent more than a third of the population and the trend is steadily increasing in an already aging population. There is thus a pressing need to understand the patterns in which multimorbidity occurs, and to better understand the nature of the care that is required to be provided to such patients.

In this thesis, we use data from the Medical Expenditure Panel Survey (MEPS) from the years 2011 to 2015 to identify …

Association Of Birth Weight And Preterm Birth With Subsequent Risk For Hypertension In Women From The Women’S Health Initiative, Christian P. Daniele

Masters Theses

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

Sexual Orientation Differences In The Association Between Cancer Diagnosis And Mental Health Outcomes, Pablo Fernandez

Masters Theses

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences.

Methods: Data are from the 2019-2021 National …

Sexual Orientation Differences In The Association Between Physical Activity And Allostatic Load: Results From The National Health And Nutrition Examination Study, Natalia I. Putnam

Masters Theses

Higher levels of allostatic load (AL), a composite measure of the impact of chronic stress on the body, are found among socially marginalized groups compared to privileged groups. AL is associated with premature aging and death, as well as a variety of chronic health conditions that impact quality of life. Effects of AL may be offset by physical activity (PA). Queer populations (including those who identify as lesbian, gay, or bisexual) may be at risk for elevated AL due to repeated exposure to discrimination in the form of sexual minority stress. There is mixed literature on sexual orientation differences in …

Forecasting Covid-19 With Temporal Hierarchies And Ensemble Methods, Li Shandross

Masters Theses

Infectious disease forecasting efforts underwent rapid growth during the COVID-19 pandemic, providing guidance for pandemic response and about potential future trends. Yet despite their importance, short-term forecasting models often struggled to produce accurate real-time predictions of this complex and rapidly changing system. This gap in accuracy persisted into the pandemic and warrants the exploration and testing of new methods to glean fresh insights.

In this work, we examined the application of the temporal hierarchical forecasting (THieF) methodology to probabilistic forecasts of COVID-19 incident hospital admissions in the United States. THieF is an innovative forecasting technique that aggregates time-series data into …

Transition Metal Catalyst (Tmc)-Embedded Bioorthogonal Nanozymes For Anticancer Therapeutics, Xianzhi Zhang

Doctoral Dissertations

Bioorthogonal chemistry offers versatile strategies for monitoring and modulating biomolecules in their native environments through abiotic chemical reactions. Bioorthogonal catalysis via transition metal catalysts (TMCs) provides the controlled activation of anticancer therapeutics, which mimics the enzymatic amplifications. However, the direct use of TMCs in living systems faces challenges such as instability, poor solubility, and low biocompatibility. Engineering the structure of TMCs can partially solve the problems, but the rapid clearance of small molecules hurdles the in vivo applications. Therefore, embedding TMCs in/onto nanomaterials to obtain bioorthogonal nanozymes enhances stability, solubility, biocompatibility, and the presence of the catalysts in biological environments …

"The Land That Feminism Forgot": Birthzillas, Madwives, And The Politics Of Chilbirth, Amber Vayo

Doctoral Dissertations

“The Land that Feminism Forgot” is an in-depth exploration of the politics of childbirth that draws together qualitative and quantitative evidence to theorize the connections between treatment in childbirth and maternal mortality. Situating the qualitative research in the larger national context, the second chapter offers a State Reproductive Autonomy Index that provides an overview of the reproductive policy landscape at the national level. The dissertation then explores the role of institutionalized childbirth, medical mistrust, and obstetric violence in the U.S.’s longstanding maternal mortality crisis and offers policy suggestions in key public health areas. Through 120 qualitative interviews with people who …

Role Of Fat Content On The Structure And Function Of Human Skeletal Muscle, Joseph A. Gordon Iii

Doctoral Dissertations

Muscle size does not fully explain variations in muscle strength. Fat content has been implicated in muscle weakness, though this relationship remains unclear. The relationship between fat and strength may vary between scales (e.g., cellular, organ, and organism). The goal of this dissertation was to clarify the role of fat in the structure and function of muscle using in vitro and in vivo techniques across multiple scales in adults 21-45 years old. Study 1 tested the agreement of intramyocellular lipid (IMCL) content between oil red o (ORO) and magnetic resonance spectroscopy (MRS) techniques. These measures of IMCL were also compared …

Mechanism-Driven Approaches And Novel Constructs For High Purity Rna Synthesis, Kithmie Malagodapathiranage

Doctoral Dissertations

RNA is poised to revolutionize medicine. By simply changing the sequence, one therapeutic can be converted into a wholly new one, with little or no change in manufacturing and formulation. While a single mRNA vaccine produced at massive scale can treat billions, the re-codability of RNA will also enable the widespread growth of personalized medicines. T7 RNA polymerase is highly efficient at the synthesis of therapeutic RNA, but is known to produce unintended RNA impurities during synthesis. These products arise from the encoded RNA rebinding the enzyme such that its 3’ end serves as a primer for extension. This leads …

Bifidobacterial Metabolism Of Fucosylated Human Milk Oligosaccharides Influences Structure And Function Of The Infant Gut Microbiome, Liv R. Dedon

Doctoral Dissertations

Human milk contains human milk oligosaccharides (HMOs) that are indigestible and pass intact through the infant gastrointestinal tract where they are available for microbial metabolism. HMOs incorporate the same monosaccharide building blocks but vary structurally in primary sequence of monomeric components. Primary sequences are further diversified by degree of polymerization, branching, and secondary modifications such as fucosylation. Fucosylated HMOs (fHMOs) are highly abundant and can account for over 30% of total HMOs. Infant-colonizing Bifidobacterium longum subsp. infantis (B. infantis) possesses a specialized gene cluster conveying the ability to metabolize fHMOs. This study presents an in-depth analysis of B. …

Mechanisms Of Cigarette Smoke-Induced Mitochondrial Dysfunction In Striated Muscle And Aorta, Stephen T. Decker

Doctoral Dissertations

Cigarette Smoke is a significant cause of morbidity and mortality in the United States, accounting for over 480,000 annual deaths. Of these deaths, the most common cause of mortality in chronic smokers is cardiometabolic diseases. Likewise, a significant portion of smokers experience some form of cardiac, vascular, or metabolic dysfunction throughout their lifetime. More specifically, smoking is shown to induce mitochondrial dysfunction in these tissues, causing an increase in oxidative damage and poor overall health. However, despite the advances in the health outcomes related to cigarette smoke exposure, the mechanisms underlying mitochondrial dysfunction in striated muscle and the vasculature remain …

Mental Health Burden And Attitudes And Intention To Seek Mental Health Services In Saudi Women Living In The United States, Wjdan A. Almutairi

Doctoral Dissertations

Background: The number of Saudi nationals immigrating to the U.S. continues to increase. Saudi women immigrants may be at increased risk for mental health disorders, including depression and anxiety, due to immigration-related stressors such as language difficulties, family separation, and cultural adjustment. Purpose: The purpose of this study was to measure anxiety and depression levels in Saudi women living in the U.S. and to assess factors affecting their intention to seek mental health services in the U.S. Methods: A descriptive cross-sectional design was employed, using online self-reported surveys. The study included a convenience sample of 160 Saudi women living in …

Differential Toxicity Of Pm2.5 Components And Modified Health Effects Modeling: A Case Study In Nepal, Jeremy Brownholtz

Masters Theses

During the latter part of the 20^th century, a transition away from coal as a major energy source in developed countries was accompanied by a notable decrease in air pollution-related deaths in those countries. Currently the same phenomenon is being observed in developing nations like China and India. However, many areas that do still rely on coal for their energy production or industrial needs also reflect a gap in research on the effects of those specific processes on local populations. Located in Nepal at the foot of the Himalayan Plateau, Kathmandu represents one such location. The local economy of …

Timing Of Hospital Admission At First Childbirth: A Prospective Cohort Study, Kristen H. Kjerulff, Laura B. Attanasio, Jennifer Vanderlaan, Kristin K. Sznajder

Health Promotion and Policy Faculty Publication Series

Background and aims

It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women’s labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress.

Methods

This was a cohort study of 1,656 primiparous women aged 18–35 years with singleton pregnancies who began labor …

Dietary Fat Quality And Serum Androgen Concentrations In Middle-Aged Men, Miika M. Wynne-Ellis, Jaakko J. Mursu, Tomi-Pekka Tuomainen, Elizabeth Bertone-Johnson, Jukka T. Salonen, Jyrki K. Virtanen

Health Promotion and Policy Faculty Publication Series

Average testosterone concentrations in men have declined over the last few decades. The reasons for this are not fully known, but changes in dietary fat quality have been suggested to have a role. This study aimed to investigate the associations of different dietary fatty acids with serum androgen concentrations.

The Challenges Of Defining Hormesis In Epidemiological Studies: The Case Of Radiation Hormesis, Ivo Iavicoli, Luca Fontana, Davide Guarino, Martina Laudiero, Edward J. Calabrese

Environmental Health Sciences Faculty Publication Series

In the current radiation protection system, preventive measures and occupational exposure limits for controlling occupational exposure to ionizing radiation are based on the linear no-threshold extrapolation model. However, currently an increasing body of evidence indicates that this paradigm predicts very poorly biological responses in the low-dose exposure region. In addition, several in vitro and in vivo studies demonstrated the presence of hormetic dose response curves correlated to ionizing radiation low exposure. In this regard, it is noteworthy that also the findings of different epidemiological studies, conducted in different categories of occupationally exposed workers (e.g., healthcare, nuclear industrial and aircrew workers), …

Educating Novice Nurses And Nurse Practitioners About Military Sexual Trauma Screening, Alyssa D. Freeman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Military sexual trauma prevalence has continually increased over the past 25 years. Exposure to sexual trauma, violence, and abuse result in notable health consequences. The Veterans Health Administration has led the integration of universal Military Sexual Trauma (MST) screening and training. Purpose: The purposes of this project were to educate novice nurses and nurse practitioners about MST and to increase their knowledge and comfort in MST screening techniques. Methods: Following an educational session, a pre- and post-study design was used to evaluate improvement in knowledge and comfort screening for MST. Thirty-two participants including PBRNR Nurse Residents, …

Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

A Toolkit To Adequately Screen Pregnant Women For Depression And Thus Increase Screening In An Outpatient Obstetrical Clinic, Katherine Doherty

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal depression is a common health complication during pregnancy. Untreated depression among perinatal women is associated with adverse health outcomes for infants and mothers. Screening during the perinatal time period is needed to identify and treat depression and to prevent adverse health outcomes.

Purpose: The purpose of this clinical project is to equip health care providers with the knowledge and tools needed to screen pregnant women for depression and thus increase the amount of screening done in an outpatient obstetrical clinic.

Methods: An evidenced- based educational tool kit was developed to increase provider knowledge of perinatal depression …

Shared Decision Making For Primary Care Patients With Medical Complexities, Cori B. Fappiano

Doctor of Nursing Practice (DNP) Projects

No abstract provided.