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Impact Of Bodyweight On Tissue-Specific Folate Status, Genome Wide And Gene-Specific Dna Methylation In Normal Breast Tissues From Premenopausal Women, Armina-Lyn Frederick

Masters Theses

Obesity has reached an epidemic level in the United States. A number of epidemiological studies have established obesity as a critical risk factor for postmenopausal breast cancer (post-BC), whereas a reverse association holds prior to menopause. A significant scientific gap exists in understanding the mechanism(s) underpinning this epidemiological phenomenon, particularly the reverse association between obesity and premenopausal breast cancer (pre-BC). This study aimed to understand how folate metabolism and DNA methylation informs the association between obesity and pre-BC. Fifty normal breast tissue samples were collected from premenopausal women who underwent reduction mammoplasty. We developed and measured the breast tissue folate …

Does The Way Parents Fight Matter? Parents' Conflict Resolution Styles And Children's Internalizing And Externalizing Problems, Alexandrea L. Craft

Masters Theses

Although the negative associations between marital conflict and children’s adjustment are well documented, less is known about how marital conflict styles (e.g., engagement, withdrawal, problem solving and compliance) are related to children’s developmental outcomes. The present study seeks to determine what types of parents’ conflict styles, during the child’s first year of life, are related to children’s behavioral outcomes in the first grade. Analyses examine the hypothesis that more conflictual conflict resolution styles of parents during a child’s infancy will predict poorer child outcomes over time. In addition, given the growing literature documenting the first year of life as a …

Sleep, And Its Relation To Non-Motor Deficits In Patients With Cerebellar Ataxia, Akshata Sonni

Doctoral Dissertations

The cerebellum is a highly connected structure, and its involvement in sleep – which is a dynamic process that is modulated by a complex set of neural systems – can come about through a number of neural pathways. We conducted two studies aimed at furthering our understanding of cerebellar involvement in sleep behavior and physiology, as well as measuring the impact of poor sleep on mood and cognition in patients with cerebellar degeneration. First, by means of an online battery including measures of sleep and neuropsychiatric function, we collected data from 176 patients with cerebellar ataxia. We found strong evidence …

Role Of Rigidity And Flexibility Of Functional Groups Within The Interior Of Supramolecular Assemblies And Their Implications, Oyuntuya Munkhbat

Doctoral Dissertations

Engineering of supramolecular assemblies at molecular level renders functional nanomaterials that present explicit response to certain environmental changes. Systematic structure-property correlation studies will unravel the fundamental design constraints of these functional nanomaterials that fulfill the emergent need. This dissertation will primarily focus on understanding the role of rigidity and flexibility of functional groups within amphiphilic assemblies and employing this basic concept in drug delivery and diagnostics applications. Supramolecular assemblies formed by amphiphilic dendrimers and polymers are preferred for this study as they exhibit high thermodynamic stability and structural flexibility. The role of aromatic interaction on the unimer-aggregate dynamic equilibrium was …

Vitamin D Status And Bone Health Among Young Adult Women, Caroline Stone

Masters Theses

Background:

Osteoporosis is estimated to affect 200 million women in the world, affecting 10% of women aged 60, 20% of women aged 70, 40% of women aged 80 and 67% of women aged 90. Osteoporosis is characterized by low bone density and increases the risk for fractured bones; however, it may be prevented with modifiable factors such as supplements, diet, and physical activity. Vitamin D deficiency leads to bone mineral density loss, as Vitamin D₃ is responsible for calcium absorption into the bones. Bone consolidation is believed to occur between 20 and 30 years old; thus, attaining peak bone …

Outreach Strategies To Recruit Low-Income African American Men To Participate In Health Promotion Programs And Research: Lessons From The Men Of Color Health Awareness (Mocha) Project, Louis F. Graham, Lamont Scott, Erus Lopeyok, Henry Douglas, Aline Gubrium, David Buchanan

Health Promotion and Policy Faculty Publication Series

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs—especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease—has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we …

Syllabus: Drinking Water, Sanitation, And Global Development, Emily Kumpel

Sustainability Education Resources

Within the past three decades, more than 2.6 billion people have gained access to an improved water source and 2.1 billion have gained access to an improved sanitation facility. However, improved does not always mean people have safe, reliable, accessible, or equitable water and sanitation services. Waterborne diseases continue to cause and estimated 500,000 deaths each year. What causes waterborne diseases, and what is the role of engineered systems in their spread or prevention? How can we evaluate interventions to improve health and well-being? How can research address these challenges?

A Metagenomic Approach To Evaluating Surface Water Quality In Haiti, Monika A. Roy, Jean M. Arnaud, Paul M. Jasmin, Steve Hamner, Nur A. Hasan, Rita R. Colwell, Timothy E. Ford

Environmental Health Sciences Faculty Publication Series

The cholera epidemic that occurred in Haiti post-earthquake in 2010 has resulted in over 9000 deaths during the past eight years. Currently, morbidity and mortality rates for cholera have declined, but cholera cases still occur on a daily basis. One continuing issue is an inability to accurately predict and identify when cholera outbreaks might occur. To explore this surveillance gap, a metagenomic approach employing environmental samples was taken. In this study, surface water samples were collected at two time points from several sites near the original epicenter of the cholera outbreak in the Central Plateau of Haiti. These samples underwent …

Developmental Exposure To 2,2′,4,4′-Tetrabromodiphenyl Ether Permanently Alters Blood-Liver Balance Of Lipids In Male Mice, Ahmed Khalil, Sebnem Eren Cevik, Stephanie Hung, Sridurgadevi Kolla, Monika Roy, Alexander Suvorov

Environmental Health Sciences Faculty Publication Series

Polybrominated diphenyl ethers (PBDEs) were used as flame-retardant additives starting 1965 and were recently withdrawn from commerce in North America and Europe. Approximately 1/5 of the total U.S. population were born when environmental concentrations of PBDE plateaued at their maximum. Accumulating evidence suggests that developmental exposures to PBDE may result in long-lasting programming of liver metabolism. In this study, CD-1 mice were exposed prenatally or neonatally to 1 mg/kg body weight of 2,2′ ,4,4′ -tetrabromodiphenyl ether (BDE-47), and changes in liver histology, transcriptome, and liver-blood balance of triglycerides were analyzed in 10 months old male offspring. In both exposure groups, …

Oxybenzone Alters Mammary Gland Morphology In Mice Exposed During Pregnancy And Lactation, Charlotte D. Laplante, Ruby Bansal, Karen A. Dunphy, D. Joseph Jerry, Laura N. Vandenberg

Environmental Health Sciences Faculty Publication Series

Hormones and endocrine-disrupting chemicals are generally thought to have permanent “organizational” effects when exposures occur during development but not adulthood. Yet, an increasing number of studies have shown that pregnant females are disrupted by endocrine-disrupting chemical exposures, with some effects that are permanent. Here, we examined the long-term effects of exposure to oxybenzone, an estrogenic chemical found in sunscreen and personal care products, on the morphology of the mammary gland in mice exposed during pregnancy and lactation. Female mice were exposed to vehicle or 30, 212, or 3000 µg oxybenzone/kg/d, from pregnancy day 0 until weaning. A nulliparous group, receiving …

Hormesis: Path And Progression To Significance, Edward J. Calabrese

Environmental Health Sciences Faculty Publication Series

This paper tells the story of how hormesis became recognized as a fundamental concept in biology, affecting toxicology, microbiology, medicine, public health, agriculture, and all areas related to enhancing biological performance. This paper assesses how hormesis enhances resilience to normal aging and protects against a broad spectrum of neurodegenerative, cardiovascular, and other diseases, as well as trauma and other threats to health and well-being. This paper also explains the application of hormesis to several neurodegenerative diseases such as Parkinson’s and Huntington’s disease, macrophage polarization and its systematic adaptive protections, and the role of hormesis in enhancing stem cell functioning and …

Transcriptomic Analysis Of Gonadal Adispose Tissue In Male Mice Exposed Perinatally To 2,2',4,4'-Tetrabromodiphenyl Ether (Bde-47), Aser Abrha, Alexander Suvorov

Environmental Health Sciences Faculty Publication Series

For the majority of lipophilic compounds, adipose tissue is traditionally considered as a storage depot and only rarely as a target organ. Meanwhile, abnormalities in adipose tissue physiology induced by chemical exposure may contribute to the current epidemic of obesity and metabolic diseases. Polybrominated diphenyl ethers (PBDEs) are a group of lipophilic flame retardants found in the majority of human samples in North America. Their ability to alter the physiology of adipose tissue is unknown. We exposed pregnant mice to 0.2 mg/kg body weight/day of BDE-47 perinatally. Transcriptomic changes in gonadal adipose tissue were analyzed in male offspring using the …

Transcriptomic Analysis Of Gonadal Adipose Tissue In Male Mice Exposed Perinatally To 2,2′,4,4′-Tetrabromodiphenyl Ether (Bde-47), Aser Abrha, Alexander Suvorov

Environmental Health Sciences Faculty Publication Series

For the majority of lipophilic compounds, adipose tissue is traditionally considered as a storage depot and only rarely as a target organ. Meanwhile, abnormalities in adipose tissue physiology induced by chemical exposure may contribute to the current epidemic of obesity and metabolic diseases. Polybrominated diphenyl ethers (PBDEs) are a group of lipophilic flame retardants found in the majority of human samples in North America. Their ability to alter the physiology of adipose tissue is unknown. We exposed pregnant mice to 0.2 mg/kg body weight/day of BDE-47 perinatally. Transcriptomic changes in gonadal adipose tissue were analyzed in male offspring using the …

Nanoparticle Exposure And Hormetic Dose–Responses: An Update, Ivo Iavicoli, Versucka Leso, Luca Fontana, Edward J. Calabrese

Environmental Health Sciences Faculty Publication Series

The concept of hormesis, as an adaptive response of biological systems to moderate environmental challenges, has raised considerable nano-toxicological interests in view of the rapid pace of production and application of even more innovative nanomaterials and the expected increasing likelihood of environmental and human exposure to low-dose concentrations. Therefore, the aim of this review is to provide an update of the current knowledge concerning the biphasic dose–responses induced by nanoparticle exposure. The evidence presented confirmed and extended our previous findings, showing that hormesis is a generalized adaptive response which may be further generalized to nanoscale xenobiotic challenges. Nanoparticle physico-chemical properties …

Community Engaged Cumulative Risk Assessment Of Exposure To Inorganic Well Water Contaminants, Crow Reservation, Montana, Margaret J. Eggers, John T. Doyle, Myra J. Lefthand, Sara L. Young, Anita L. Moore-Nall, Larry Kindness, Roberta Other Medicine, Timothy E. Ford, Eric Dietrich, Albert E. Parker, Joseph H. Hoover, Anne K. Camper

Environmental Health Sciences Faculty Publication Series

An estimated 11 million people in the US have home wells with unsafe levels of hazardous metals and nitrate. The national scope of the health risk from consuming this water has not been assessed as home wells are largely unregulated and data on well water treatment and consumption are lacking. Here, we assessed health risks from consumption of contaminated well water on the Crow Reservation by conducting a community-engaged, cumulative risk assessment. Well water testing, surveys and interviews were used to collect data on contaminant concentrations, water treatment methods, well water consumption, and well and septic system protection and maintenance …

A Toolkit To Assist Massachusetts School Nurses Start Elementary School Substance Use Prevention Education Programs, Caitlin Pettengill

Doctor of Nursing Practice (DNP) Projects

Purpose: Massachusetts currently only mandates fifth-twelfth grade substance use prevention. Literature states it is counter productive to wait until the adolescent years to initiate substance use prevention due to the adolescent developmental stage of social conformity. Starting evidence-based substance use prevention education in early elementary school will arm children with the knowledge and confidence they need to make healthy choices and reduce future high school drug rates.

Methods: A toolkit was created to assist Massachusetts elementary school nurses to start a substance use prevention program in their schools/districts. The toolkit was presented and evaluated in January 2018 by the …

Evidence-Based Interventions: Improving Influenza Vaccination Rate Among Health Care Workers (Hcws) Targeting Direct Care-Givers, Jennelyn Fraser-Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Influenza is a contagious disease affecting over three million people every year. It is associated with yearly seasonal outbreaks which increases the risk of mortality among immune-compromised, hospitalized clients, clients in long-term care facilities and also enhances the risk of infection in healthcare workers (HCWs). Nosocomial infections and employees’ absenteeism are often associated with the flu. A high influenza vaccination rate in health care professionals reduces the risk of influenza infection as well as being a cost- effective strategy to reduce lost work hours. A Joint Commission criterion for accreditation for healthcare facilities is to achieve a 90% …

Measuring The Impact: A Re-Aim Framework For Evaluation Of A Needle Exchange Program, Lindsay Novacek

Doctor of Nursing Practice (DNP) Projects

Background: Needle exchange programs (NEPs) have been widely documented over the past three decades as an effective and economic approach to controlling human immunodeficiency virus (HIV). As of July 1st, 2016, these programs have been legalized in North Carolina. Purpose: To perform stage 1 of an evaluation of a needle exchange program in North Carolina by utilizing a public health framework: the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Methods: First, the RE-AIM framework was used to create a plan for a program evaluation of a local NEP. Then, the first stage of the evaluation was completed. NEP program participants …

Screening For Traumatic Brain Injuries (Tbi) In Veterans: A Quality Improvement Project To Change The Identification And Referral Process In Primary Care Providers., Chiara Simonini

Doctor of Nursing Practice (DNP) Projects

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide …

Using Cognitive Behavioral Therapy To Treat Insomnia In Adults, Alexandra Christodoulou

Doctor of Nursing Practice (DNP) Projects

Background: Insomnia is a physically, mentally, and psychologically complicated and distressing medical condition that can affect adults with or without comorbid conditions. Research indicates that cognitive behavioral therapy (CBT) is an underutilized, but extremely beneficial intervention that may support individuals in overcoming insomnia and other comorbid conditions, without ever ingesting a pill. Unfortunately, CBT is underutilized due to the patient educational time requirements; therefore, medication is often prescribed as a first line of treatment for insomnia. Adults suffering from insomnia with or without comorbid conditions such as psychiatric disorders or cancer have benefitted from CBT as opposed to oral …

Hypertensive Management For African American Patients, Aleksandrya Bracey-Asiedu

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The rates of angioedema amongst African American patients using angiotensin- converting- enzyme- inhibitors (ACE-I) are five times greater than non-African American counterparts (01.-07 percent vs. 0.5-3.5 percent). Although ACE-I agents are widely prescribed, they have less therapeutic control in hypertension amongst this group of patients and high incidences of life threating side effects.

Methods: The purpose of this quality improvement (QI) project was to assess provider knowledge related to established guidelines from the Joint National Committee (JNC) on hypertension management, as well as their knowledge of the side effects of ACE-I for African American patients. A pre …

Reducing Readmissions In Bipolar Patients With Discharge Interventions, Alexandra Steeves

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this DNP project was to evaluatea discharge protocol with interventions to improve the process of discharge from the in-patient setting and transition the patient into the community.

Methods: This program evaluation centered on evaluating a discharge protocol currently in place and adding revised interventions to strengthen the discharge planning process. De-identified data was viewed on readmission rates and interviews were conducted with stakeholders involved with the discharge process.

Results: There were a total of twelve participants in the evaluation period of pre and post evaluation interviews. Review of the interviews resulted in four themes relating to …

A Quality Improvement Project For Co-Occurring Disorders In Outpatient Behavioral Health, Erin Sheehan

Doctor of Nursing Practice (DNP) Projects

Purpose: Patients with mental health diagnoses often have co-occurring alcohol use disorders, which can exacerbate their psychiatric symptoms. A standardized assessment tool should be utilized for screening for alcohol use disorders in outpatient mental health programs so that interventions can be implemented when a co-occurring disorder is identified. The purpose of this project was to provide clinicians with education and to improve the process for screening patients with mental health disorders for problematic drinking behaviors to implement recommended interventions when appropriate to improve the overall quality of the patient’s care and increase the clinician’s knowledge and confidence in treating co-occurring …

A Quality Improvement Project To Improve Type 2 Diabetes Mellitus Screening In Asian Americans Using Body Mass Index Cut Point Of 23, Annie Samuel

Doctor of Nursing Practice (DNP) Projects

Background: Asian Americans are at a higher risk for Type II Diabetes than other groups and disproportionately develop Type II Diabetes Mellitus at younger ages, although having a lower Body Mass Index (BMI) compared to non-Hispanic whites.

Methods: A group of 22 Nurse Practitioners (NP) in New York were presented an evidence-based educational intervention along with a five-item pre-test and post-test to determine if they had acquired new knowledge on the issue. A follow-up survey was conducted to test if the intervention changed individual NP practice in screening Asian Americans in adult primary care clinics.

Results: The overall mean …

Stop The Stigma! Eliminating Implicit And Explicit Bias Toward Adult Obese Women Receiving Gynecological Care: A Quality Improvement Project To Cultivate Empathy And Increase Knowledge Of Best Practices, Mary Ellen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Increased weight carries significant health risks, yet obese individuals face stigma, implicit and explicit bias by health care providers that affects quality of care and increases health care avoidance. Obese women may delay or avoid gynecological care due to fear of stigma, inadequate equipment and embarrassment about their weight. Review of Literature: In the United States, 70.7% of adults, almost three quarters of the adult population are overweight or obese. Purpose: The purpose of this quality improvement project was to improve the quality of care and empathy toward obese women by health care providers in an OB/GYN practice through …

Managing Patients At High-Risk For Breast Cancer: An Elearning Module For Primary Care Providers, Erin Chaney

Doctor of Nursing Practice (DNP) Projects

Women at high-risk of developing breast cancer must be screened appropriately and educated about breast cancer reduction strategies much earlier than those of average risk. The National Comprehensive Cancer Network (NCCN) (2017) has identified guidelines for the care of this group. This project focused on the development of education for providers, specifically an eLearning module, to help translate guidelines into practice. Providers of adult primary care (including internal medicine and family practice) from four clinics in Snohomish County, Washington, were asked to participate in an eLearning module regarding the care of patients at high-risk for breast cancer. Repeated measures surveys …

Screening Adults With Substance Use Disorder For Adverse Childhood Experiences, Teri Murtha

Doctor of Nursing Practice (DNP) Projects

Background and purpose-Exposure to adverse childhood experiences results in increased morbidity and mortality among individuals with substance use disorders. Screening for histories of childhood trauma, and integration of trauma-informed care is lacking among health care practitioners. Integrating screening for histories of childhood abuse in person’s seeking treatment for substance abuse disorders can facilitate identification of individuals interested in additional support and resources to support their recovery. The purpose of this study was to assess the effectiveness and feasibility of a screening interview protocol for ACEs and to determine the presence of ACEs among individuals with substance use disorder (SUD) …

Educating Health Care Professionals To Improve Communication In Advance Care Planning, Laura E. Clubb

Doctor of Nursing Practice (DNP) Projects

DNP Project Goal:The goal and expected outcome of this DNP project was to increase providers’ self-reported preparedness and comfort levels by 50% when discussing advance care planning (ACP) and end of life wishes with patients.

Background: The Institute of Medicine designed ACP as a national health priority. However, health care professionals often do not facilitate discussions of ACP with patients, even in patients with chronic or life-limiting illnesses. This occurs due to professionals’ lack of knowledge about ACP, lack of comfort when discussing the issue, and a misperception that the patient may be too young or not sick enough …

Improving Patient Discharge Satisfaction Scores By Implementing Teach-Back Instructions In A Community Hospital Emergency Department (Ed): A Quality Improvement Project, Kristen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy and patient satisfaction play a role in healthcare today and it is the responsibility of all providers to ensure that patients are educated about the care they received in the ED and what they should be doing upon discharge. The teach-back method ensures patients have a complete understanding of their ED stay and discharge instructions.

Purpose: The purpose of this quality improvement project was to increase patient satisfaction scores by implementing the evidenced-based, patient-centered, teach-back method for all patient education opportunities.

Methods: The DNP student led the ED leadership team and staff nurses in a quality improvement …

Medication Reconciliation In An Ambulatory Care Community Mental Health Practice, Matthew Bock

Doctor of Nursing Practice (DNP) Projects

Purpose: To improve medication safety among behavioral health patients at a community-based outpatient psychiatric practice in Western Massachusetts through implementation of an evidence-based medication reconciliation protocol.

Methods: Gaps in the current medication reconciliation process were identified by reviewing the current process with outpatient supervisors in the practice. A sample of 25 patients, the majority with more complex comorbid medical conditions, were selected to participate in an evidence-based medication reconciliation process. Medications, both prescribed and over the counter, were reconciled either in office or in the home.

Results: There was a significant increase in the number of medications identified post-intervention. On …