Medicine and Health Sciences Commons^™

Navigating Insulin Access For Pediatric Type 1 Diabetes: Caregivers' Experiences And Challenges, Ella Anderson

Doctoral Dissertations

Between 2012 and 2018, the annual 14% increase in insulin prices made Type 1 Diabetes (T1D) the most expensive chronic health condition, significantly raising out-of-pocket costs for uninsured or underinsured individuals in the United States (Hayes & Farmer, 2020; Willner et al., 2020). This study utilized a qualitative content analysis methodology to explore the challenges and experiences of parents with children diagnosed with T1D with accessing insulin for their child. Five participants from various areas of the United States responded to open-ended questions both in person and via Zoom. The analysis revealed three main themes: pragmatics of managing diabetic care, …

Toxoplasma Gondii: The Dynamics Between Free-Roaming Cats And Wildlife, Tania J. Dawant

Doctoral Dissertations

Toxoplasma gondii is a single celled, apicomplexan parasite with a complicated life cycle. Felids are the definitive hosts, and shed oocysts in their feces, which are extremely hardy in the environment. Intermediate hosts maintain a life-long infection with the parasite encysted in tissues. Due to this phenomenon, being seropositive is indicative of infection. The transmission dynamics between cats and wildlife is not completely understood. With its zoonotic risk, it is important to understand how T. gondii is spreading between domestic and wild populations. We sought to deepen the understanding of the dynamics between free-roaming cat populations and select wildlife species. …

Device-Based Measures Of Maternal Physical Activity, Pregnancy Nocturnal Glucose, Postpartum Sleep, And Infant Adiposity, Bethany R. Hallenbeck

Doctoral Dissertations

This dissertation presents physical activity, sedentary behavior, and bedrest (sleep estimation) data from ActiGraph devices worn during pregnancy and postpartum. Analyses of these data consider how these behaviors may relate to each other and health outcomes in the mother and child. The research aims to bridge the gap in understanding the intricate relationship between physical activity health behaviors and maternal and infant health metrics during the critical phases of pregnancy and postpartum. For this work, we employed repeated measures mixed modelling and integrated device-based, research-grade, ActiGraph data with clinical measures and survey responses to elucidate the multifaceted dynamics influencing a …

A Pattern Matching Algorithm For Self-Adjusting Basal Rates In Insulin Pump Systems, Lauren Smith

Doctoral Dissertations

In a Type 1 Diabetic, Insulin can be administered in a pump system. There are two types of insulin that must be given: basal and bolus. Basal insulin is a long-acting form of insulin that works in the background while fasting, while Bolus insulin is rapid/short acting given in response to food to immediately begin working to lower blood sugar.

Modeling in Diabetes can be represented by algorithmic approaches ranging from simple autoregressive models of the Continuous Glucose Monitor time series to multivariate nonlinear regression techniques of machine learning. Other examples of modeling in Diabetes include prediction models of hypoglycemia …

Mental Health And Experiences Of Pregnancy Among Black Women And Birthing People With Type 1 Diabetes (T1d), Madeleine E. Marcus

Doctoral Dissertations

This dissertation explored the potential effects of intersections of oppression (i.e., anti-Black racism, diabetes discrimination, and sexism) on mental health and pregnancy experiences among Black women and birthing people with Type 1 diabetes (T1D). Previous studies about pregnancy and T1D have included mainly white, cisgender women. Three participants qualified for inclusion in the present study and participated in semi-structured interviews, which the researcher analyzed using an interpretative phenomenological analysis (IPA) framework. Participants described feeling uncertain about whether aspects of their pregnancy experiences were related to obstetric and/or medical racism. Similarly, participants sometimes seemed uncertain about how racism may affect their …

Implantable Medical Devices For Local Drug Delivery And Tissue Regeneration To Combat Chronic Bacterial Infection, Caroline J. Billings

Doctoral Dissertations

Local drug delivery has been an area of exceptional interest in the treatment of chronic bacterial infections, particularly in areas where there are medical implants placed. Medical implants are widely utilized and are becoming increasingly popular with time. With the increasing use of medical implants, concomitant bacterial infection is also increasing, and this type of bacterial infection can be exceedingly difficult to clear. The following body of work focuses on implant-associated bacterial infection, with an emphasis on chronic Staphylococcus aureus (S. aureus) infection, particularly osteomyelitis. Specifically, this work is focused within the scope of utilizing locally implantable medical …

Role Of Temperature, Transmission Pathways, And Pathogen Load In Batrachochytrium Salamandrivorans Epidemiology, Edward Davis Carter

Doctoral Dissertations

Amphibian populations are experiencing dramatic population declines. Amphibian diseases are one of the major reasons for these declines. A newly described fungal pathogen, Batrachochytrium salamandrivorans (Bsal), has been recently introduced to Europe and is currently decimating European salamander populations. Sampling efforts have not detected Bsal yet in the United States in captive or wild populations. Disease management hinges on knowing how environmental, host, and pathogen interactions influence disease occurrence and severity. Understanding routes of pathogen transmission is also critical as knowledge of these routes can elucidate management strategies. In Chapter I of my dissertation, I measured how environmental …

Cat Covid, Cmv And Chemokines, Oh My!, Trevor Hancock

Doctoral Dissertations

Cytomegalovirus (CMV) is an important pathogen infecting most humans worldwide. CMV infection within immunocompromised individuals can cause severe morbidity and potential mortality. Disease during CMV infection is due to virus dissemination and subsequent inflammation. Host immune cells lie at the intersection potentially mediating both. The CMV-encoded viral chemokine vCXCL-1 is a proposed virulence factor in mouse models increasing immune cell recruitment and disease. However, the primary immune cell mediator is undetermined. To identify targets, Chapter 2 examines CXCR2 expression (receptor for vCXCL-1) among various mouse tissues and human peripheral blood under steady-state conditions. In vitro, isoforms of HCMV’s vCXCL-1 …

Design And Development Of The Urban Population Health Observatory To Improve Disease Surveillance And Response, Whitney Brakefield

Doctoral Dissertations

Chronic and infectious diseases have a profound impact on the quality and length of life of populations that suffer from these conditions. Scientists, physicians, and health officials are seeking innovative approaches to decrease the morbidity and mortality of deadly diseases. Incorporating artificial intelligence and data science techniques across the health science domain could improve disease surveillance, intervention planning, and policymaking. In this dissertation, we describe the design and development of the Urban Population Health Observatory (UPHO), an explainable knowledge-based multimodal big data analytics platform. A common challenge for conducting multimodal big data analytics is integrating multidimensional heterogeneous data sources, which …

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Anti-Inflammatory And Chemopreventive Activity Of Lunasin From Tofu Whey For The Management Of Gastrointestinal Diseases, Cindy Andrea Nieto Veloza

Doctoral Dissertations

Gastrointestinal diseases such as inflammatory bowel diseases (IBD) and colorectal cancer (CRC) are pathological conditions associated with chronic inflammation, characterized by intestinal damage, debilitating symptoms, and detrimental health consequences. The increased risk of CRC in IBD patients, and the adverse effects associated with current therapeutic strategies, point out the need for safer alternatives to reduce chronic inflammation in the bowel. Lunasin is a bioactive peptide naturally occurring in soybeans, with chemopreventive and anti-inflammatory properties demonstrated in several extra-intestinal diseases. However, to date, there is no evidence of the biological activity of lunasin on the gastrointestinal tract as a target site. …

Prevalence Of Rats And Rodent Borne Pathogens Across Post-Katrina New Orleans, Bruno Marco Ghersi

Doctoral Dissertations

Disasters are happening at an increasingly higher rate and intensity a trend that is expected to continue as more humans migrate to coastal urban areas. Disasters, and as importantly, disaster recovery can affect how native and pest populations will recover. My aim was to improve understanding of disease risk by evaluating the socioecological conditions that have shaped commensal rat recovery and distribution, as well as the pathogens they carry, across New Orleans after Hurricane Katrina. I first estimated relative abundance and distribution of commensal rats from rodent trapping conducted between mid-2014 and early-2017 across 96 sites in 10 areas of …

Investigating The Regulation Of Indole-3-Acetic Acid Production By The Plant Associated Microbe Pantoea Sp. Yr343, Kasey Noel Estenson

Doctoral Dissertations

The auxin indole-3-acetic acid (IAA) plays a central role in plant growth and development and many plant-associated microbes produce IAA. Several IAA biosynthetic pathways have been identified in microbes which use the precursor tryptophan. Pantoea sp. YR343, which was isolated from the Populus deltoides rhizosphere, is a robust plant root colonizer that produces IAA. Using genomic and metabolomics analyses, we predicted that the indole-3-pyruvate (IPA) pathway is the major pathway in Pantoea sp. YR343 for IAA production. To better understand IAA biosynthesis and the effects of IAA exposure on cell physiology, we performed proteomics on Pantoea sp. YR343 grown in …

Health Assessment Of Two Reintroduced Populations Of American Martens (Martes Americana) In Michigan, Maria Catherine Spriggs

Doctoral Dissertations

The American marten (Martes americana) was extirpated from Michigan during the early-20th century due to loss of vast areas of mature conifer forest and unregulated trapping. The species was reintroduced into the Upper Peninsula (UP) and Northern Lower Peninsula (NLP) during the mid-20th century. While the American marten population in the UP has grown and is doing well, the population in the NLP has been less successful. The reasons for the limited success of the NLP population are unknown, but may include lack of suitable habitat, limited reproductive success, poor genetic diversity, disease, or negative environmental impacts. American …

Brown And Beige Adipocytes: Effects Of Inflammation And Nutritional Intervention, Jiyoung Bae

Doctoral Dissertations

Recent findings of brown adipocytes and brown-like or beige adipocytes, capable of dissipating energy as heat, in adult humans have promised new hope for obesity treatment and prevention. Understanding of the regulation of brown and beige adipocytes will provide novel strategies to reach the goal. Pattern recognition receptors (PRR) are responsible for inflammation in adipose tissue, which leads to adipose dysfunction and obesity associated chronic diseases. It has been shown that PRR activation induces inflammation, leading to insulin resistance in white adipocytes and white adipose tissue (WAT). However, the roles of PRR activation in brown adipocytes and brown adipose tissue …

Epidemiology Of Select Species Of Filarial Nematodes In Free-Ranging Moose (Alces Alces) Of North America, Caroline Mae Grunenwald

Doctoral Dissertations

North American moose (Alces alces) are a culturally and economically valued species. Recent population declines raise concern for the survivability of this natural resource. The Minnesota population has experienced the most dramatic decline, with a 60% loss in total numbers since 2006. Nematode parasites, particularly some species of filarids, are important pathogens of moose and could be contributing to morbidity and mortality. This study investigates the eco-epidemiology of two filarial parasites of moose: Rumenfilaria andersoni and Elaeophora schneideri. By surveying cervid species from six U.S. states, we discovered R. andersoni was present in moose from all sample locations …

Role Of Microrna-155 In Herpes Simplex Virus Pathogenesis, Siddheshvar Bhela

Doctoral Dissertations

Ocular infection with herpes simplex virus 1 (HSV-1) can result in a chronic immunoinflammatory stromal keratitis (SK) lesion that is a significant cause of human blindness. These lesions are mainly orchestrated by IFN-gamma producing CD4+ T cells (Th1) and neutrophils. HSV being neurotropic in nature can also disseminate into the brain and lead to herpes simplex encephalitis (HSE). In this study we investigated the role of miR-155 in the pathogenesis of HSK and HSE.

The first part of the dissertation (I) reviews literature regarding the contribution of miRNAs in innate and adaptive immune responses. It also focuses on their involvement …

Implementation Of Motivational Interviewing In A Multidisciplinary Hiv Clinic In An Academic Medical Setting, Lucy Ledesma

Doctoral Dissertations

Purpose: People living with HIV (PLWH) struggle with medication adherence. Antiretroviral therapy (ART) requires greater than 95% adherence to prevent HIV drug resistance and treatment failure. Motivational interviewing (MI) is an effective counseling method designed to enhance health behavior change. This project determined the effectiveness of a two-day introductory MI training course on participant MI knowledge, perception of MI effectiveness, perception of client behavior change, and likelihood of MI use in a Midwest outpatient HIV clinic.

Participants: Seven clinical and non-clinical members of the multidisciplinary care team completed the two-day MI training course. Approximately 82% of the participants had never …

Associations Of Total Activity Counts And Physical Activity Intensity Levels With The Metabolic Syndrome: A Structural Equation Modeling Approach, Dana Lizbeth Wolff

Doctoral Dissertations

To clarify the protective benefits of physical activity (PA), epidemiologists and public health researchers continue to seek improved methods of assessing PA. In particular, accelerometers have gained acceptance with researchers as they provide reliable estimates of PA and can record both the amount and intensity of ambulatory movement. However, there is concern that accelerometer data reduction techniques may not provide quantitatively accurate measurements of time spent in various PA intensity categories. One way to circumvent these inaccuracies is to use the accelerometer-derived total activity counts (TAC), which is a more direct expression of what the monitor records.

In order to …

Geographic And Socioeconomic Risk Factors For Sporadic Cryptosdporidiosis And E. Coli Infection In East Tennessee, Ingrid Elizabeth Luffman

Doctoral Dissertations

This research examines risk factors for sporadic cryptosporidiosis and Escherichia coli (E. coli) O157 infection in East Tennessee, using case-control and retrospective ecological approaches. Multiple models and approaches are used to identify risk factors for the two diseases, and to examine the effect of scale on risk for disease in the individual and in the population. Risk factors examined are animal density, land use, geology, surface water impairment, poverty rate and availability of private water supply. The research objectives are, first, to identify risk factors for E. coli O157 and cryptosporidiosis in East Tennessee by relating disease data …

Modulating T Cell Responses To Control Stromal Keratitis, Tamara Antia Veiga Parga

Doctoral Dissertations

Herpetic stromal keratitis (SK) is an immunoinflammatory corneal lesion caused by herpes simplex virus (HSV) infection. This infection, in some cases, can result in a chronic immunoinflammatory lesion that is the most common cause of infectious blindness in the developed world. Studies in animal models have revealed that SK lesions are orchestrated mainly by IFN-gamma producing CD4+ T cells (Th1) and neutrophils that infiltrate the corneal stroma.

The first part of this dissertation (I) reviews literature on HSV induced corneal SK immunopathology and the role of Tregs in viral infections. It also focuses on the understanding of HSV-1 induced immunoinflammatory …

Growth Regulation Of Pancreatic Cancer Cells And Their Normal Cells Of Origin By Nicotinic Acetylcholine Receptors, Mohammed Hussein Al-Wadei

Doctoral Dissertations

Pancreatic cancer is the fourth leading cause of cancer mortality with a five-year survival rate of less than 5 %. It shows no symptoms until it has reached an advanced stage upon which it has metastasized to distant organs limiting therapeutic options. Several studies have identified smoking, alcohol, diabetes and pancreatitis as risk factors for pancreatic cancer. While smoking is a well-documented risk factor for this malignancy, there still remains a controversy on whether alcohol can act as a risk factor itself or cooperatively enhances the effects of other risk factors.

Previous reports provide evidence that nicotinic acetylcholine receptors (nAChRs) …

The Relationship Of Basic Conditioning Factors, Knowledge, Self-Care Agency, Self-Care Behavior, And Urinary Sodium Excretion Of Hypertensive Older Adults: Testing Orem’S Self-Care Theory, Pratsani Srikan

Doctoral Dissertations

Understanding the powerful factors of sodium reduction benefits older adults by leading to reduce many health risks, lower the health care cost and diminished economic and social burden. This study had two aims: 1) to explore to what degree four factors--selected basic conditioning factors, knowledge of sodium reduction, sodium reduction self-care agency, and sodium reduction self-care behavior predict urinary sodium excretion in hypertensive seniors, 2) to test whether these variables related to sodium reduction were congruent with Orem’s Self-Care Theory.

Based on this theory, internal and external conditioning factors were proposed as either positively or negatively influencing an individual’s knowledge …

Effects Of Increased Step Width On Knee Joint Biomechanics In Healthy And Knee Osteoarthritis Older Adults During Stair Descent, Maxime Robert Paquette

Doctoral Dissertations

Stair negotiation is one of the most challenging tasks for older adults especially for those suffering from knee osteoarthritis (OA). To date, no studies have investigated the effects of increased step width (SW) on knee joint biomechanics. The purpose of Study One was to investigate the effects of increased SW on peak internal knee abduction moment and other lower extremity variables during stair descent in healthy older adults. The purpose of Study Two was to investigate the effects of increased SW on peak internal knee abduction moment, knee pain and other lower extremity variables during stair descent in medial compartment …

Geographic Disparities Associated With Stroke And Myocardial Infarction In East Tennessee, Ashley Pedigo Golden

Doctoral Dissertations

Stroke and myocardial infarction (MI) are serious conditions whose burdens vary by socio-demographic and geographic factors. Although several studies have investigated and identified disparities in burdens of these conditions at the county and state levels, little is known regarding their geographic epidemiology at the neighborhood level. Both conditions require emergency treatments and therefore timely geographic accessibility to appropriate care is critical. Investigation of disparities in geographic accessibility to stroke and MI care and the role of Emergency Medical Services (EMS) in reducing treatment delays are vital in improving health outcomes. Therefore, the objectives of this work were to: (i) classify …

Diagnosis And Management Of Horses With Equine Metabolic Syndrome (Ems), Kelly Ann Chameroy

Doctoral Dissertations

In horses, a painful and often debilitating disease known as laminitis can result in impaired function and, in severe cases, euthanasia. Equine Metabolic Syndrome (EMS) is a syndrome in horses that results in development of laminitis and is characterized by the presence of general and/or regional adiposity (“cresty neck”), aberrations in blood lipid concentrations, insulin resistance (IR) and/ or hyperinsulinemia. Therapies have focused on improving the state of obesity and insulin resistance with the goal of diminishing the likelihood of laminitis development. A definitive cause for laminitis has not been established, but hyperinsulinemia and IR are likely candidates as experimental …